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Tag Archives: seen

Seen in office, sent to ER seen again question

Posted on by
Here’s a scenario that I’m drawing a blank on what to do.

Patient came into the office (Urology) for scrotal swelling. Doctor examined patient – who was a new patient – and sent him to the ER for an emergent ultrasound to rule out abscess or torsion. He saw the patient in the ER later and ended up doing surgery. Both E&Ms got billed and, weirdly, they got paid. Then BCBS wised up and took back the money on the hospital charge. I know if the patient gets admitted from the office, you essentially build the office visit into the admission code, but what about this situation? Can we bill both? We’re querying the doctor to see if he planned to see the patient in the ER or if he was on call and got called in when the ultrasound was read. If it’s the latter, we might have a leg to stand on in appeal, but what if it’s the former?

Thanks!!!

Medical Billing and Coding Forum

Seen in office, sent to ER seen again question

Posted on by
Here’s a scenario that I’m drawing a blank on what to do.

Patient came into the office (Urology) for scrotal swelling. Doctor examined patient – who was a new patient – and sent him to the ER for an emergent ultrasound to rule out abscess or torsion. He saw the patient in the ER later and ended up doing surgery. Both E&Ms got billed and, weirdly, they got paid. Then BCBS wised up and took back the money on the hospital charge. I know if the patient gets admitted from the office, you essentially build the office visit into the admission code, but what about this situation? Can we bill both? We’re querying the doctor to see if he planned to see the patient in the ER or if he was on call and got called in when the ultrasound was read. If it’s the latter, we might have a leg to stand on in appeal, but what if it’s the former?

Thanks!!!

Medical Billing and Coding Forum

Proper coding for patients seen by a specialist during their observation stay

Posted on by
I just wanted to confirm with the panel the correct way to bill for an exhisting pateint who was seen in the hospital during the observation stay portion prior to being formally admitted as an inpatient. We are an oncology practice and one of our oncologist was asked to consult on a patient for Hematology reasons, while the patient was still registered as being in observation. The physician obliged and saw the patient, but marked teh encounter as an initial inpatient visit (99221-99223).

Per CMS guidelines (PUB 100-04 Claim Processing Manual, Transmittal 2282, section 30.6.8 Payment fo Hosptial Observation Services and Observation of Inpateint Care Services (including admission and discharge), "Payment for an initial observation care code is for all the care rendered by the ordering physician on the date the patient’s observation services began. All other physicians who furnish consultations or additional evaluations or services while the patient is receiving hospital outpatient observation services must bill the appropriate outpatient service codes."

Unfortunately, it does not go into detail on how to code if the patient being seen was already and exhisting patient of the consulting physician. Since we are told to use the appropriate outpatient codes (99211-99215, 99201-99205), the question was asked which would be the more appropriate code type of code, exhisting or new patient? I think an argument could be made for both code types, but my gut feeling is that we are bound by the 3yr rule when using the outpatient codes. Is this the more prudent way to approach these scenarios?

Greg Quinn, CPC, CPPM, CHONC

Medical Billing and Coding Forum

patient seen before admission (inpatient/observation)

Posted on by
Thoughts on this? Are rules still the same that you have to look back and see if the pt is new/established?

EX: HP completed on 03/12/18, but there is no admit/observation status until 03/13/18

CPT : all EM services provided by the physician in conjunction with the admission are considered part of the initial hospital care
when performed on the same DATE as admission.

So the provider is actually performing the HP, before the date of admission. We cannot consider it part of the initial care, because it was not performed on the same DATE as admit

Medical Billing and Coding Forum

99211 when patient left before being seen by provider

Posted on by
I work in an urgent care/primary care setting. We have standing triage orders based off complaints so x-rays and labs are ordered by an MA (usually) before the providers see patients. Sometimes the patients leave after having x-rays or labs but before the providers seen the patient. I am under the impression you cannot bill an E&M for these visits but others say to go with a 99211. We don’t bill "incident to" really. Our claims are filed under the extenders’ names and numbers with the supervising provider as the co-signer.

Is the 99211 appropriate? Where can I find the supporting documentation?

Thanks!!!!!

Medical Billing and Coding Forum

Medicare patient seen for gingivitis with history of Mitral Valve Prolapse-Dx code

Posted on by
Hello! I am hoping for some direction on correct coding of a claim. Patient has Medicare, she came to our physician office because of gum and teeth pain. She was diagnosed with gingivitis. She has a history of mitral valve prolapse, due to this she was put on an antibiotic right away. Medicare does not cover services related to teeth or gums so they denied the claim with primary dx of gingivitis. We added the dx for history of mitral valve prolapse but I feel this should be the secondary diagnosis. Our biller called Medicare and was told as long as the gingivitis diagnosis is on the claim they will not pay. I certainly feel that we need to have the gingivitis diagnosis on the claim. Do you agree gingivitis primary diagnosis, hx of MVP secondary? Looking for reassurance…..:o

Thank you for your response.

Medical Billing and Coding Forum