Billing a Hospital Admit

November 19, 2010

How to bill for a successive office visit and hospital admission

Question: I have a question that I have seen answered multiple times differently. When a patient is seen in the office and sent to the hospital with orders, but the physician does not come to the hospital until the next day, can the physician bill for an initial hospital visit on that date? I have seen guidance that the physician needs to be physically present at the hospital on this date to have the face-to-face encounter allowing him to bill for the admission, and then I have read guidance that he can bill even if he didn’t come to the hospital that day. I have read that he could bill for the inpatient admission on the morning he does come in to see the patient and the office visit would be billed the day the patient was admitted.

My problem is I have a physician who comes into the hospital the next morning and backdates an entry for the prior day (office visit day and hospital admit date). He only writes “H&P” for this date, however the H&P is not dictated until the actual day the physician comes to the hospital to see the patient. What is he trying to accomplish by doing this? To me, it is very suspicious and makes me think that he is not allowed to bill for the hospital admission unless he sees the patient face to face in the hospital. Can someone help me with this?

Answer: Anyone who is backdating anything is operating outside the rules. A hospital admission service requires the presence of the physician in the hospital on the day he bills the admit service.

You can go to the hospital and perform your admission services the day you send the patient to the hospital and bill the admit that day. You will not bill the office visit if you do it this way.

You cannot see the patient in the office and send him to the hospital, and bill the admit that day if you didn’t go there. This is often called a “direct admit” and practitioners seem confused about how to do this.

If you don’t go the hospital until the next day, and that is when you perform your initial inpatient service -which is the name of the CPT subcategory the admit codes come from - then you bill the admission codes 99221-99223 with the date of service on the second day. This also allows you to bill the office visit the previous day.

I don’t see what the provider in question has to gain from playing with the dates. If he backdated the admit to the previous day - in addition to essentially fraudulent behavior - he loses the office visit. Good luck.

Bill Dacey, CPC, MBA, MHA, is principal in the Dacey Group, a consulting firm dedicated to coding, billing, documentation, and compliance concerns. Dacey is a PMCC-certified instructor and has been active in physician training for more than 20 years. He can be reached at billdacey@msn.com or physicianspractice@cmpmedica.com.

This question originally appeared in the February 2010 issue of Physicians Practice.