Emergency room verses out patient charges

One of our Doctors was asked by the ER Doctor to do a consult to see if a patient needed to be admitted. Our Doctor decided to admit the patient as an observation on the 20 of the month and documented it as such. Now here is the problem a bed was not available so the patient stayed in the ER waiting for a bed to become available for two days and on the 22 a bed became available and the patient was then admitted as an inpatient. Our Doctor failed to do another H/P for the admission. Can someone tell me how this should be coded? Thank you

Emergency room versus out patient charges

In general, match the status of the physician service, with the status of the facility.

On the 20th, bill an obs admission, 99218--99220
On the 21st, bill an outpatient visit, 99212--99215
the fact that the patient is still in the ED doesn't change their status

On the 22nd, bill an H&P IF and ONLY IF the MD dictated an H&P that day, 99221-99223
If not, bill a subsequent hospital visit, 99231-99233

If the patient status was changed to inpatient on the 20th, don't bill the OBS admission, bill the inpatient admission codes.

If the patient status was changed on the 21, don't bill the office outpatient codes, bill inpatient codes.

Clear as mud, eh?

Emergency room verses out patient charges

Thank you so much for your help. That was the way I decided that it needed to be billed and it is good to know that I made the right chose.