The information provided here applies to Medicare coding. Be sure to check with your Medicare Administrative Contractor (MAC) for additional information and clarification on these and other items. You should also contact your local insurance carriers to determine if private insurers follow Medicare's lead on all coding matters.
Q: Can You Bill for a Telephone Admission to the Hospital?
SCENARIO: Your partner admits over the phone a patient to the hospital after a call from the ER at 10:00 pm. You see the patient the next morning at 7:00 am. When is the admission billed? The day of the 7:00 am visit. Billers may be confused that the admission date from the hospital and your billing date do not match. You need to advise them that this is considered the correct action.
Care also must be taken when you decide the patient may be discharged. If the patient has been in the hospital eight or more hours, you may use the codes for the same day admit and discharge, which are #99234 and #99235, and #99236, depending on the complexity of the visit. If the patient is in the hospital fewer than eight hours, you may bill only for the admit. Remember, an admission note must be written and/or dictated. If the patient is in the hospital for more than 24 hours, you may bill separately for the admission and the discharge.
WARNING: You must document carefully if a high level visit is charged for an admission on the same day that an outpatient E/M visit is documented, particularly if the patient is sent home in less than 24 hours.