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inpatient or out patient

Laurie Posted Tue 09th of July, 2019 08:14:01 AM
We have a patient that had a 50715 which super coder states as an inpatient only code and the patient was in the hospital observation/ outpatient. Can I still bill the 50715? Thanks, Laurie
SuperCoder Answered Wed 10th of July, 2019 07:41:05 AM

Hi,

As per CMS guidelines, “Inpatient only” services are generally, but not always, surgical services that require inpatient care because of the nature of the procedure, the typical underlying physical condition of patients who require the service, or the need for at least 24 hours of postoperative recovery time or monitoring before the patient can be safely discharged.

There is no payment under the OPPS for services that CMS designates to be “inpatient only” services. Hence, you cannot bill CPT 50715 for hospital observation/ outpatient.

 

Please also check the below link for better understanding (Page no. 138, 180.7 - Inpatient-only Services): 

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c04.pdf 

 

Thanks

 

 

Laurie Posted Wed 10th of July, 2019 07:45:18 AM
Thanks you!
SuperCoder Answered Thu 11th of July, 2019 00:26:36 AM

Thank you, happy to help.

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