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How to code for an inpatient admit after patient in outpatient observation

Teresa Posted Thu 31st of May, 2012 23:04:55 PM

A patient was put int outpatient observaton and stayed there for 2 days. The status was changed to inpatient admit. Colorado mediciad system does not allow for an outpatient visit within 24 hours of an admit. The patient was in outpt OBS from 5/17 thru 5/19, then changed to inpatient until subsequent C-section delivery on 5/22/12. How do I bill for 6 days of care given to our patient with the 2 different status circumstance?

SuperCoder Answered Fri 01st of June, 2012 07:53:21 AM

For DOS 05/17 --> Bill observation care code from range 99218-99220
For DOS 05/18 --> Bill subseq. observation care code from range 99224-99226
For DOS 05/19 --> If the Pt. has been admitted to hosp. on this day from Obs. care, the physician should report only the Initial InPt. admission code (99221-99223) with modifier AI. DO NOT bill any Obs. care code onthis date. (As per CPT manual instruction) The initial hospital care code reported by the admitting physician should include the services related to the observation status services he/she provided on the same date of Inpatient admission. [If another physician also visits the pt. on this date after admission, then code initial hosp. visit code 99221-99223, but w/o AI modifier]

For 05/20-05/22 --> Each day, if the admitting ohysician has only visited the Pt., then bill subsequent hospital visit code (99224-99226) once for each day. If a physician other than the admitting doctor has come for subsequent visits on these days, then bill 99224-99226 once for every day.

On 05/22 --> Since C-sec surgery was performed, bill the surgery CPT code for the surgeon. If the same admitting doc. or the subsequent visiting doc. only has performed the surgery, then do not bill any E/M on this day prior to Surgery. The pre-surgery E/M would be inclusive of the surgery code.

Just another note, if the surgeon has made a pre-surgery usual E/M service on 05/21 (a day prior to Sx), then also do not bill that regular usual E/M service separately.

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