We are an independent practice from the hospital, so we sometimes have difficulty communicating with hospital if they change the status of patient stay from inpatient to 23 hr observation or vice versa.

We have a case of patient being admitted to ICU chest pains, 10/10, short of breath but enzymes checked to be negative. Patient was admitted on a Friday afternoon so my guess was case management was not able to precert? (with BCBS).

Patient was discharged on a Sunday.

Our physician was under the impression it was an inpatient at ICU (which at the time of service patient was not in good shape). So we billed it service location as Inpatient.

After a week or so, we looked again at hospital site and discovered patient was changed back to 23 hr observation.

Question:

1. Does the 2 midnight rule apply here or it is not a strictly 2 midnight? Patient admitted noon of Friday discharged Sunday afternoon? How come it was still outpatient 23 hr observation on hospital status?
2. We billed/coded (not sent out yet pending clarification with hospital) inpatient visit 99254 Blue Select ? But should we change it to outpatient visit 99245 to match the hospital status?
3. We are debating if we have hold our claims and double check with hospital if they changed status from OP to IP or vice versa before submitting our claims?
(Too much work but if necessary will do it)

Has anybody experienced this? Suggestions?

Thanks!