admit/discharge same day

Pt was discharged & readmitted same day. (same place of service)
We didn't think you can bill for both a discharge & admission. Would we bill admission only?
Thanks

Comments

  • I would agree with that.. admit

    Karyn Cardenas-Foray, CPC, CPMA ,CHCA, CEMC,CIMC,CSEMC
    AHIMA ICD10 PROFICIENT
    Government Reimbursement Analyst-Sharp Health Care
    PFS-CCD 3rd Floor
    858-499-4382

  • January 2002 CPT Assistant makes it clear that the admit/discharge same day E/M category (99234–99236) may be used in cases where the patient is discharged and then re-admitted later in the same day. You still have an admit and discharge happening on the same date, just not in the "normal" order. The exception mentioned in the article was when separate facilities are involved. Separate facilities warrant "separate reporting" by way of the physician using separate discharge and admission E/M codes.

    Seth Canterbury, CPC, CPC-I
    Clinical Data Quality Education Department
    University of Florida Jacksonville Physicians, Inc.
    653 West Eighth Street
    Tower I, Suite 606
    Jacksonville, FL 32209
    (912) 227-5965

  • Seth,
    any guidance you can give on this topic would be greatly appreciated. These drive me up a wall. I thought it was based on hours spent, where it would be the observation code set.

    Karyn Cardenas-Foray, CPC, CPMA ,CHCA, CEMC,CIMC,CSEMC
    AHIMA ICD10 PROFICIENT
    Government Reimbursement Analyst-Sharp Health Care
    PFS-CCD 3rd Floor
    858-499-4382

  • Medicare does have additional requirements that go a bit further than CPT, such as the patient being in observation status for at least 8 hours on the date in question, yes, but has never specifically contradicted the implication from CPT that the observation/discharge same day code can be used when these events occurred in reverse order (as with your situation).

    I know using the code in this way sounds a bit hokey, though, and not all may feel comfortable applying this CPT allowance to Medicare. If not, you may either do what was advised by a couple others, and bill using an admission code only, or bill separate admit and discharge E/Ms (with Modifier 25 attached to the second) and appeal the inevitable denial by explaining the patient was re-admitted soon after discharge.

    Seth

  • Hi Seth
    The original email scenario was not mine; but I chimed in because I come across this often, where the provider is utilizing this code set 99234-99236 and Medicare will not pay our provider charge as they are telling me that the same provider was paid under a Part A (?) I didn't understand this at all, but when I looked at the amount of hours that the patient was there it was under the amount of time For the code set according to their manual. I was under the impression that the patient had to be in 8 or more hours for this code set. The IOM chapter 30.6.8 says if a patient receives observation care for less than 8 hours on the same calendar date the initial observation care code set should be used and there will be an admit but no discharge is reported (this is where most of my scenarios fell into) and sometimes they cross over into the next day by a few hours so I assumed that was also an issue when trying to bill 99234-99236.. Can you provide feedback for this, I figured it was an incorrect code set based on some hospital status. So I looked to correction into the OBSERVATION CODE SET

    Karyn Cardenas-Foray, CPC, CPMA ,CHCA, CEMC,CIMC,CSEMC
    AHIMA ICD10 PROFICIENT
    Government Reimbursement Analyst-Sharp Health Care
    PFS-CCD 3rd Floor
    858-499-4382


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