decisionhealth Newsletters, Coder Pink Sheets - 2009 Issue 4 (April)
Ophthalmologist must see patient in hospital to bill ‘admission’
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Article Overview
This premium article covers hospital admission billing concepts in ophthalmology when care begins in the office and continues in the hospital. It discusses how same-day and next-day hospital encounters affect evaluation and management reporting, how inpatient care is treated when services occur in multiple settings, and why documentation and site-of-service timing matter for claim review. The article is aimed at ophthalmologists, coders, and billers who need to understand hospital admission workflow and E/M service reporting at a general level.
Why This Topic Matters
Accurate handling of office-to-hospital transitions affects whether a hospital admission can be reported, how E/M services are grouped, and whether claims may be denied or require additional review.
Article Sections
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Hospital admission and same-day office care
Explains the relationship between an office encounter and a hospital admission when both occur on the same day. It addresses the general reporting framework for initial hospital care in this setting.
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Including work from multiple sites of service
Describes how services from more than one setting may be considered when determining the overall level of inpatient care. It also notes documentation and claim review considerations at a broad level.
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When the hospital encounter occurs the next day
Covers situations in which the physician does not see the patient in the hospital until the following calendar day after admission from the office. It discusses how the timing of the hospital visit affects reporting.
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Avoiding use of an unlisted E/M code
Addresses a strategy for managing the timing of the history and physical relative to the hospital encounter. It explains the operational reason the article discusses alternative reporting paths.
What You Will Learn
- How the timing of office and hospital encounters affects admission-related reporting
- How inpatient care may incorporate work performed in more than one setting
- Why same-day and next-day hospital encounters are treated differently for reporting purposes
- What documentation and workflow issues can affect claim review in these scenarios
Who Should Read This
- Ophthalmologists
- Medical coders
- Medical billers
- Practice managers
- Compliance staff
Codes Discussed
Code Ranges Discussed
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