Coding, Classification and Reimbursement

Coding Outside Procedures

  • 1.  Coding Outside Procedures

    Posted 14 days ago
    Can someone direct me to the documentation that states for a Medicare inpatient that is transferred to another facility for a procedure, and comes back to your facility within 24 hours, that your hospital can code for the procedure. The facility that performed the procedure is not going to bill Medicare they are going to bill your facility.
    Thank you,

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    Pamela Phillips
    Sr. Director of Him
    Cerner Corporation
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  • 2.  RE: Coding Outside Procedures

    Posted 13 days ago
    The only situation I'm familiar with where that might be true, would be a rehabilitation stay, where the patient is transferred for a procedure and then directly back for continuing rehab.   I'm not familiar with that practice in other patient types though.

    If you're referring to rehab, i'll chip in a little time to help find the reference, but it'll take a short bit... honestly, I hate trying to locate Medicare references... one can spend hours on that site.

    If youre not rehab, please let me know.





  • 3.  RE: Coding Outside Procedures

    Posted 12 days ago
    We are an acute care.
    Thank you,

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    Pamela Phillips
    Sr. Director of Him
    Cerner Corporation
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  • 4.  RE: Coding Outside Procedures

    Posted 13 days ago
    There is no Medicare rule - it is usually an arrangement between the two facilities.  Check with the finance department.





  • 5.  RE: Coding Outside Procedures

    Posted 13 days ago

    If by arrangement and they bill you, you can code for it if you are reimbursing that facility directly.  If in doubt, call your Medicare Rep.  I work in an LTCH and in this scenario, we would code it since we are reimbursing that facility.

    dh

     






  • 6.  RE: Coding Outside Procedures

    Posted 13 days ago
    Pamela,
    You're looking for the Medicare Claims Processing Manual, Chapter 3 Section 40.2.5  (starts on pg 114 of the below link)
    https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c03.pdf

    This above reference talks about patient returning on the "same day", while your question asks about within 24 hours.  I personally would treat the same, as the hospital B cannot bill outpatient services while the patient is receiving Part A services in another hospital.  Hospital A has to bill for the entire care - and hospital A will pay hospital B for the outpatient procedure.  "...The acute care PPS hospital is responsible for the other entity's services per common Medicare practice."

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    Sheila Goethel
    Coding Services Senior Manager
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