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Pathology IN-Patient vs OUT-patient

Kathy Posted Thu 18th of June, 2015 14:48:14 PM

In our local hospital for medicare patient it appears the DOS or DOsurgery does not always match. EX: pt has a Hysterectomy on March 19 but is not admitted until March 20. All of the documentation we have points to the 19th. We are billing OP for the pathology because according to Hospital records the pt was not admitted until the 20th. Or after the surgery. Does this sound logical or are we billing incorrectly?
Thank you,

SuperCoder Answered Fri 19th of June, 2015 05:48:10 AM

Your hospital billing it incorrectly. Hospital should prepare document according to actual date of admission and actual date of surgery. The pathology date should also include the correct Date of surgery and sample taken date. If you submit claims with false dates, this will be considered as fraud by insurance company.

Kathy Posted Fri 19th of June, 2015 16:09:05 PM

If the Hospital does not admit the pt until after surgery and the pt started out as an out patient, but then admitted. Should the entire stay be IN-PT even though it started as an out-pt?

SuperCoder Answered Mon 22nd of June, 2015 01:34:53 AM

Ideally for the major surgery patient needs to get admitted one day prior or on the same day of the surgery and the whole stay will be considered as an inpatient status. Since your scenario does not meet this ideal scenario, it would be better if you get in touch with your insurance company to verify how/if they cover this service.

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