decisionhealth Newsletters, Coder Pink Sheets - 2009 Issue 2 (February)
Interventionalist must see patient in hospital to bill “admission”
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Article Overview
This article discusses how evaluation and management billing may be affected when a physician sees a patient in the office and then the patient is sent to the hospital. It focuses on the distinction between same-day hospital involvement and next-day hospital evaluation, and it notes the role of documentation and payer review in these scenarios. The content is useful for physicians, coders, and billing staff who work with inpatient admission-related E/M services.
Why This Topic Matters
Correctly distinguishing office care from initial hospital care can affect claim selection, documentation needs, and whether additional review or appeal may be required.
What You Will Learn
- How hospital-related evaluation and management services are distinguished from office-based services in admission scenarios.
- Why the timing of the physician’s hospital encounter matters for billing.
- How documentation and separate problem considerations can affect claim handling.
- Why some cases may involve an unlisted evaluation and management service.
Who Should Read This
- Physicians
- Interventionalists
- Medical coders
- Billing staff
- Practice administrators
Codes Discussed
Code Ranges Discussed
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