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Pt. seen in ER in am and then admitted to hospital later in the day?

Mercy Posted Tue 19th of July, 2011 19:09:11 PM

My physician saw the patient in the ER in the morning, wanted to admit the patient. Pt. wanted to try the care at home. Pt. advised if pain worsen would need to come back to be admitted. Pt. leaves ER.
Later at night patient returns, my physicians gives verbal admission orders. He DOES NOT seen the patient that night. He does see the patient the next day.

What do I charge?

Do I charge ER for day 1 and hospital admit for Day2 or only Hospital admit for Day 1? Again, the face to face with the patient was in the ER in the early a.m on day 1

Thank you,
Marci

SuperCoder Answered Wed 20th of July, 2011 03:58:31 AM

Day 1: Patient was provided ER service and discharged home. Even if the patient admitted on the same day, Initial hospital care was provided on Day 2 which is not an admission from ER status. So, going by logic we should code: Day 1 as ER, Day 2 as Initial Hospital care.
...
I would also like to put the adjudication point of view:
That the ER wants to admit, but for the patient's wish was allowed home, but ER also orders for admit if the pain worsens. Even though there is a break in transfer of ER to Admit, but virtually this admission was based on the premise of ER evaluation and order on the same day to Admit on same night.
So, as it is going to overpay hospital for ER as well as Initial Hospital Care, where it would have been only Initial Hospital Care only for Day 2 (without any ER for day 1)
So, it is my suggestion that all information to be collected and thoroughly scrutinized to know the fact before you take a decision for E/M coding as this can be a possible scenario for adjudication intervention.

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