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OK, this one is mine, Discharge and Admit within Hours. This is a very unusual case,
I never heard of something like this.
Q: "I have a patient that was being discharged from the hospital from one physician & within
a couple of hours she was admitted by a different physician. Can we use the admit/discharge
code (99234, 99235, 99236)? If you cannot bill this code could you give a reason why
we could not? Thank you, Debi."
Now, I just realized, I think I read the question wrong. I thought she was saying that they
were admitted and discharged the same day and then they came back the same day. Now,
I'm realizing, this is kind of backwards. It's like a discharge and then an admit. Let's
go to my original understanding since that's how I answered it. That I thought we had two
events -- an admit and discharge earlier in the day and another admit later in the day.
A: So, the general rule of thumb with E/M codes is you get one per customer, so one
E/M code per physician per patient per day. There are some exemptions but that's the general
rule. So, they have this thing called the "carryover concept." Let's say the patient
was in observation and the observation is basically to decide are they going to be admitted
Let's say they get admitted on the same day, they've been in observation for a couple of
hours and then they get admitted to the hospital. They can only bill one E/M code so is it going
to be the observation code or the initial hospital code? The answer is the last place
they were seen, so it's the initial hospital. That's why it's called carryover. You don't
lose the work that you did in the first setting. You carry over any history that you did, any
exam that you did, any medical decision making that you did, and you just carry it over to
the new setting and combine it with any work that you did there.
So, if you have a patient who's admitted to observation or inpatient and they're discharged
the very same day, they have this unique code that is called admit and discharge code. Keeping
to the rule of one E/M code per day, even if they had two different events, you only
get one code.
In this case, I was reading it, he had two different physicians so you should be able
to get two E/M billed on the same day because of two different physicians; but the payers
might view it as one E/M per practice versus per physician per day. You need to check that
out with the payer. If that's the case, you only bill the one admit and discharge code.
Let's look at the codes here. I just did a couple grabs from my scanned page here. These
are the three levels of codes: 99234, 99235, and 99236. This is something I have my students
do, have them write: A&D same day, A&D same day. So when they turn to these codes, it
jumps right out of them, that that's what these are. Basically, it says: including admission
and discharge on the same date. If that's your patient situation, these are the three
codes you should choose from. Then, the little notes on the margin it's just a technique
that we use to teach E/M.
But, a 236 as you can see, it's a comprehensive history, comprehensive exam, and high complexity
medical decision making. If you had to carry over work from a previous session, you're
only billing the one code, you could carry it over. So, maybe, they did a comprehensive
history, but they did low medical decision making. But after you combined everything
from the two sides, they might have done the high complexity medical decision making. So,
maybe a bump us up to 236 or 235, so you can carry over the documentation work, if you
will, to get the higher level that they deserve.
So, off-the-cuff reading this question again. If it's, "I have a patient that was being
discharged from the hospital from one physician & within a couple of hours she was admitted
by a different physician." See, I need a little more information, is this the same practice,
so it's the same 1500-form that you're billing? I don't think that's the intent of the A&D
codes, it's supposed to be admission then discharge, discharge then admission. I think
this is definitely be payer specific and you might be fine since it's different physician.
Just for physician A, bill your discharge; for physician B, bill your admit. Hopefully,