hospital charge vs. office charge

If a patient is seen in the office and sent directly to the hospital, what do you charge? A hospital charge or office visit?

Office charge vs Hospital charge

If a patient is seen in the office and then admitted to the hopital you only charge for the hopital admit.

or you can...

charge a level V office visit if your office note meets that criteria and see the patient the next morning at the hospital and do a level I admit H&P.

Initial Hospital Visit Charge

According to CPT, the initial hospital care codes, 99221-99223, are for "the first hospital inpatient encounter with the patient by the admitting physician."


Scenario
#1 - You see a patient in your office. During the course of that encounter, you admit the patient to the hospital as an inpatient, but do not see the patient in the hospital that day. The next day, you visit the patient in the hospital for the first time. In this case, you would code an office visit (99201-99215) for services provided on the first day and an initial hospital care code (99221-99223) for service provided on the second day, if all elements of the initial hospital care code were met (minimum of detailed history and exam and straightforward medical decision making documentation), if all criteria are not met for initial care bill as a subsequent hospital care charge (99231 – 99233).

Note: If you admit the patient during the course of the encounter (in the clinic) but do not see the patient at the hospital the same day, charge the appropriate code for the office visit (99201-99215).


#2 – You see a patient in your office. During the course of the encounter, you admit the patient to the hospital as an inpatient and also visit the patient in the hospital, later that day, to assess if the patient is medically stable. In this case, you would code only the initial hospital admit code.

Note: If you admit from clinic and see the patient in the hospital on the same day, you would only bill the initial hospital care code (99221-99223)*. You can use the documentation of the office visit to raise the level of the hospital admission code.

#3 – You see and admit the patient in the hospital setting. In this case you would bill the hospital admit code.*

* All documentation elements of the initial hospital care code are required to be met (minimum of detailed history and exam and straightforward medical decision making documentation).

Initial Hospital Visit Charge

Ckipka,

That was a great post about this topic. Would you mind posting it as an article so that it will be easy to find?

The question and answer format of this forum makes it easy to ask and have an answer to a specific question. The encyclopedia format of Codapedia provides the answers in a way that is easy to search, and is unique to the site.

Initial Hospital Visit Charge

I agree and interpret the guidelines to mean that the physician has to see the patient face to face in the hospital in order to submit an initial inpatient encounter. The physician can roll the work performed in the office setting into the services performed inpatient on that same day. Is there anyone who disputes that detail.

I maybe dispute it...

If I see someone in the office and I send them for admission, I often write in the chart "Admitted" and I dictate the H&P and write orders and bill for initial hospital care. I submit no charge for the office visit. I do not see the patient that day in the hospital; my first hospital visit is the next day and is billed as subsequent hospital visit. I don't think CMS would object to this- it is less costly than a high level office visit and a hospital admission charge.

I have never read that the patient must be "seen face to face" in the hospital (although that does not mean it is not written somewhere.)

hospital charge vs office charge

It depends---did the doctor go to the hospital and see the patient on the same day---or did he see the patient in the office and send patient to the hospital but did not actually see the patient in the hospital setting. in this situation, an office visit would be billed for the visit today---and the first initial hospital visit would be billed the first date (possibly day after admission) when the physician physically sees the patient in the hospital