Same Day admit & Discharge
Understanding Hospital Admission and Discharge Coding
When coding for hospital admissions and discharges, it's crucial to understand the guidelines for reporting various scenarios. Proper coding ensures accurate reimbursement and compliance with billing regulations. Here, we'll delve into the specifics of hospital admission and discharge coding based on the Current Procedural Terminology (CPT) guidelines.
1. Admission and Discharge on the Same Date
- When a patient is admitted to inpatient hospital care for less than 8 hours on the same date, the physician should report an Initial Hospital Care service from the CPT code range 99221 – 99223. The Hospital Discharge Day Management service (CPT codes 99238 or 99239) should not be reported in this scenario.
2. Admission and Discharge on Different Dates
- If a patient is admitted to inpatient care and discharged on different calendar dates, the physician should report an Initial Hospital Care from the CPT code range 99221 – 99223, as well as a Hospital Discharge Day Management service, CPT code 99238 or 99239.
3. Stay of 8 Hours but Less Than 24 Hours
- For patients admitted to inpatient hospital care for a minimum of 8 hours but less than 24 hours and discharged on the same calendar date, Observation or Inpatient Hospital Care Services (Including Admission and Discharge Services), from CPT code range 99234 – 99236, should be reported.
4. Documentation Requirements for Billing Observation or Inpatient Care Services (Including Admission and Discharge Services), CPT codes 99234 - 99236:
The physician must satisfy the E/M documentation guidelines for admission to and discharge from inpatient observation or hospital care.
The medical record should include documentation stating that the stay involves 8 hours but less than 24 hours.
It should identify that the billing physician was present and personally performed the services.
The admission and discharge notes should be written by the billing physician.
5. Physician Services Involving Transfer From One Hospital to Another:
- Physicians may bill both the hospital discharge management code and an initial hospital care code when the discharge and admission do not occur on the same day if the transfer is between different hospitals, different facilities under common ownership, or between the acute care hospital and a PPS exempt unit within the same hospital when there are no merged records. In other transfer circumstances, the physician should bill only the appropriate level of subsequent hospital care for the date of transfer.
6. Initial Hospital Care Service History and Physical That Is Less Than Comprehensive:
- When a physician performs a visit or consultation several days prior to an admission and on the day of admission performs less than a comprehensive history and physical, he or she should report the office visit or consultation that reflects the services furnished and also report the lowest level initial hospital care code (i.e., code 99221) for the initial hospital admission.
7. Initial Hospital Care Visits by Two Different M.D.s or D.O.s:
- Physicians use the initial hospital care codes (codes 99221-99223) to report the first hospital inpatient encounter with the patient when he or she is the admitting physician. Only one M.D. or D.O. is considered the admitting physician, and others should bill the inpatient evaluation and management services codes that describe their participation in the patient’s care.
8. Initial Hospital Care and Nursing Facility Visit on Same Day:
- Only the initial hospital care code should be paid if the patient is admitted to a hospital following a nursing facility visit on the same date by the same physician. Physicians may not report a nursing facility service and an initial hospital care service on the same day.
In conclusion, understanding the guidelines for hospital admission and discharge coding is essential for accurate and compliant billing. Proper documentation and adherence to coding guidelines ensure that physicians receive appropriate reimbursement for their services.