Coding, Classification and Reimbursement

Inpatient vs Outpatient admission -- Billing for Facility

  • 1.  Inpatient vs Outpatient admission -- Billing for Facility

    Posted 14 days ago
    Hello,

    A patient admitted as an inpatient and had Surgery. Surgery was performed without complications but due to some other complications transferred to other Hospital on the same day. How do we bill this encounter as an Inpatient or outpatient case?

    As the pt discharged before 24 hours and there are no room charges I think we should bill it as an outpatient case. Is there a way to bill this as an inpatient case?

    Please let us know what you suggest!

    Thank you!

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    SP
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  • 2.  RE: Inpatient vs Outpatient admission -- Billing for Facility

    Posted 13 days ago
    If the patient was actively admitted to inpatient surgery, I'd bill as an IP.   The reason for the surgery would be PDX, and the hospital to which the patient was transferred would report the complication that is presumably the reason for transfer as PDX





  • 3.  RE: Inpatient vs Outpatient admission -- Billing for Facility

    Posted 13 days ago
    I agree with Jonathan - for Medicare, you will need a physician order for inpatient status to bill as an inpatient.  The order cannot be post-dated.
    For non-Medicares, it may depend on the payers request for status, for they often advise what they prefer.  Contract language may define "inpatient", but most make in/outpt decisions when called/advised of patient care.

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    Sheila Goethel
    Coding Services Senior Manager
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