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Inpatient admit dilemma

Kathy Posted Fri 09th of August, 2013 08:53:01 AM

Physician in small hospital "A" sees a patient as a cardiology consultant for chest pain. The cardiologist uses the appropriate consultant code in hospital "A" and then decides to transfer the patient to a larger hospital "B" for inpatient admit as the attending. Can the Cardiologist submit a consultant code in hospital "A" and an admit inpatient code in hospital "B" same day?

SuperCoder Answered Fri 09th of August, 2013 19:13:28 PM

The only reference I found to this specific scenario basically said, “experts disagree, but most suggest bundling the consult into the admit.” That was a 2004 Cardiology Coding Alert article.

That approach seems to make sense if you consider that if the doctor saw the patient in the ER or office and then admitted the patient same day, only the initial hospital visit would be billed (at least under Medicare rules). Medicare Claims Processing Manual (MCPM), Chap. 12, Section 30.6.9.1, states: “When the patient is admitted to the hospital via another site of service (e.g., hospital emergency department, physician’s office, nursing facility), all services provided by the physician in conjunction with that admission are considered part of the initial hospital care when performed on the same date as the admission.” http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf

Additionally, it may be difficult for a doctor to meet the requirements for an initial hospital code if he already saw the patient earlier in the day and performed an E/M and tries to report both separately.

MCPM does discuss transfers, but it seems to focus on same admitting physician in both case because it’s about when to code both discharge and initial hospital code:

“Physicians may bill both the hospital discharge management code and an initial hospital care code when the discharge and admission do not occur on the same day if the transfer is between:
•Different hospitals;
•Different facilities under common ownership which do not have merged records; or
•Between the acute care hospital and a PPS exempt unit within the same hospital when there are no merged records.

In all other transfer circumstances, the physician should bill only the appropriate level of subsequent hospital care for the date of transfer.”

There’s also the initial hospital code “per day” definition indicating it covers all services that day. From the MCPM: “Contractors pay a physician for only one hospital visit per day for the same patient, whether the problems seen during the encounters are related or not. The inpatient hospital visit descriptors contain the phrase “per day” which means that the code and the payment established for the code represent all services provided on that date. The physician should select a code that reflects all services provided during the date of the service.”

If I find something more authoritative for the scenario, I'll post again!

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