Outpatient Facility Coding Alert - 2018 Issue 6
Reader Question: Pinpoint Place of Service in This ED E/M Scenario
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Article Overview
This reader Q&A discusses how to think about place of service and related evaluation-and-management reporting when a patient is first seen in the emergency department, then admitted to the hospital, and later has another procedure performed while in inpatient status. It is aimed at coders and billing staff who handle hospital-based physician services and want to understand the broad reporting issues raised by same-day care across different settings.
Why This Topic Matters
Accurate setting attribution affects claim processing and helps avoid denials or duplicate E/M reporting when care spans the emergency department and inpatient hospital status on the same day.
Article Sections
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Question
Introduces a scenario involving emergency department evaluation, admission to inpatient care, and subsequent treatment of an additional injury on the same day.
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Answer
Addresses the reporting and place-of-service issues raised by the scenario and discusses the related hospital-based service considerations.
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Heed this
Highlights payer scrutiny of same-day E/M reporting and references a contractor review focus relevant to hospital admission timing.
What You Will Learn
- How place of service can differ between emergency department care and inpatient hospital care
- How same-day services across settings raise E/M reporting concerns
- Why payer review attention matters for claims involving multiple E/M services on the same day
- How hospital-based physician services may be considered when a procedure occurs after admission
Who Should Read This
- Professional coders
- Hospital billing staff
- Physician practice billers
- Compliance staff
Codes Discussed
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