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In office procedure while pt is in facility

Lori Posted Thu 12th of September, 2013 17:09:48 PM

A pt was brought to our office for a epidural injection 62311 pos 11. But the pt was also inpatient status at a hospital. Is there a modifier because medicare is denying pmt due to the inpatient status.

SuperCoder Answered Fri 13th of September, 2013 10:53:04 AM

We had a similar question not too long ago. When a patient is an inpatient, she's an inpatient -- not a switch back and forth patient. If circumstances call for some type of treatment that the patient can get in the MD's office but not the hospital, the patient needs to be discharged from the hospital, treated at the MD's office, and then readmitted to the hospital.

Since this patient apparently only went to the office for an injection, it seems a bit strange (to me) that the injection couldn't be done in the hospital. Makes me wonder what the situation was.

Lori Posted Wed 25th of September, 2013 19:35:25 PM

There were scheduling conflict in the OR so they just wheeled the patient to the office where we have our own procedure room.

SuperCoder Answered Wed 25th of September, 2013 23:26:19 PM

A patient can't be considered an inpatient if they leave the facility for some type of treatment in the physician's office. He/she is either an inpatient being treated in the hospital, an outpatient being cared for in the outpatient services department (but still on that facility's grounds, not going to a doctor's office) or is discharged and no longer receiving care as either an inpatient or outpatient. My idea is, that's why Medicare is denying the claim.

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