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Discharge Day vs. Leaving Day

Pamela Posted Wed 07th of March, 2018 12:58:48 PM
I have a multiple part question. Scenario "Admitting provider has a patient in Observation and sees the patient on Day 2 and writes "Discharge patient tomorrow after _____test." (the test could be stress test, PFT, MRI, US or other). Patient is not seen by provider the next day. I know CMS allows the physician to do the discharge the day before the patient leaves as long as the visit is face-to-face. My questions are: 1. Can they make the discharge contingent on when a test is completed? 2. Can the patient be billed on the facility side after the discharge is written? 3. Can the patient continue medications and other orders after the discharge is written? 4. Who is responsible for giving the patient the test results, the MD the patient follows up with? I realize if the test is abnormal, the discharge can be rescinded if it requires continued hospitalization for treatment.
SuperCoder Answered Thu 08th of March, 2018 02:13:21 AM


After thorough research, there is no reliable CMS guidelines, data, or article available to justify the above scenario. Discharge process only ends when the patient leaves the facility. Preparing discharge summary is a part of discharge process. Here is the list of tasks that the AMA says to include in discharge planning:

  • final examination;
  • discussion of the hospital stay;
  • all the time spent by the discharging physician, as well as time spent by associates, even if that time is not continuous;
  • instructions to all relevant caregivers for continuing care;
  • preparation of discharge records, including time spent dictating a discharge summary;
  • prescriptions; and
  • referral forms for any follow-up services.

It is generally prepared the day before the patient leaves the hospital/facility. As per above scenario and upon discussion with the coding experts, since the tests are still pending and the chances are that they may come abnormal, so the physician has a right to cancel the discharge and bill the visit as sebsequent day visit. The patient will be billed after the discharge is written till he/she leaves the facility. The patient will continue taking medications and has to follow the orders till he/she leaves the facility. Physician who is following up the patient will be only responsible for the test results.



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