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Same day office visit (RHFMC)

Chuck Posted Thu 08th of May, 2014 10:15:28 AM

Our doctor saw a patient in the clinic for asthma exacerbation. The patient was later admitted to the hospital for the same condition. I understand it to be true that he won't get paid for both the clinic visit and the hospital admission. My question is, how should we code this so that the doctor is reimbursed for both visits?
Thank you!

SuperCoder Answered Thu 08th of May, 2014 11:45:39 AM

To bill for an inpatient admission (99221-99223), Medicare requires that you provide initial inpatient service to the patient at the hospital and document what you provided. You cannot bill for two E/M services on the same day. However, you don't have to lose reimbursement for the services. You can combine the office visit (99201-99215) and the hospital inpatient admission and choose your level of E/M service based on that. In many cases, the inpatient admission has higher reimbursement than the office visit.

For example, your combined services may meet the requirements for a level-three inpatient admission, resulting in higher reimbursement than a level-two office visit. When you report the hospital admission, document the work performed in the office.

If you have not reported an inpatient admission for a patient and then bill for subsequent hospital care, you could raise a red flag with Medicare. The rule of thumb is to combine the two same-day services and then determine the E/M level. If you only bill for an office visit and not the hospital admission, you could also be losing money.

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