Coding Certification - Discharge and admit within hours

OK, this one is mine, Discharge and Admit within Hours. This is a very unusual case, I never heard of something like this. Q: "I have a patient that was being discharged from the hospital from one physician & within a couple of hours she was admitted by a different physician. Can we use the admit/discharge code (99234, 99235, 99236)? If you cannot bill this code could you give a reason why we could not? Thank you, Debi." Now, I just realized, I think I read the question wrong. I thought she was saying that they were admitted and discharged the same day and then they came back the same day. Now, I'm realizing, this is kind of backwards. It's like a discharge and then an admit. Let's go to my original understanding since that's how I answered it. That I thought we had two events -- an admit and discharge earlier in the day and another admit later in the day. A: So, the general rule of thumb with E/M codes is you get one per customer, so one E/M code per physician per patient per day. There are some exemptions but that's the general rule. So, they have this thing called the "carryover concept." Let's say the patient was in observation and the observation is basically to decide are they going to be admitted or not? Let's say they get admitted on the same day, they've been in observation for a couple of hours and then they get admitted to the hospital. They can only bill one E/M code so is it going to be the observation code or the initial hospital code? The answer is the last place they were seen, so it's the initial hospital. That's why it's called carryover. You don't lose the work that you did in the first setting. You carry over any history that you did, any exam that you did, any medical decision making that you did, and you just carry it over to the new setting and combine it with any work that you did there. So, if you have a patient who's admitted to observation or inpatient and they're discharged the very same day, they have this unique code that is called admit and discharge code. Keeping to the rule of one E/M code per day, even if they had two different events, you only get one code. In this case, I was reading it, he had two different physicians so you should be able to get two E/M billed on the same day because of two different physicians; but the payers might view it as one E/M per practice versus per physician per day. You need to check that out with the payer. If that's the case, you only bill the one admit and discharge code. Let's look at the codes here. I just did a couple grabs from my scanned page here. These are the three levels of codes: 99234, 99235, and 99236. This is something I have my students do, have them write: A&D same day, A&D same day. So when they turn to these codes, it jumps right out of them, that that's what these are. Basically, it says: including admission and discharge on the same date. If that's your patient situation, these are the three codes you should choose from. Then, the little notes on the margin it's just a technique that we use to teach E/M. But, a 236 as you can see, it's a comprehensive history, comprehensive exam, and high complexity medical decision making. If you had to carry over work from a previous session, you're only billing the one code, you could carry it over. So, maybe, they did a comprehensive history, but they did low medical decision making. But after you combined everything from the two sides, they might have done the high complexity medical decision making. So, maybe a bump us up to 236 or 235, so you can carry over the documentation work, if you will, to get the higher level that they deserve. So, off-the-cuff reading this question again. If it's, "I have a patient that was being discharged from the hospital from one physician & within a couple of hours she was admitted by a different physician." See, I need a little more information, is this the same practice, so it's the same 1500-form that you're billing? I don't think that's the intent of the A&D codes, it's supposed to be admission then discharge, discharge then admission. I think this is definitely be payer specific and you might be fine since it's different physician. Just for physician A, bill your discharge; for physician B, bill your admit. Hopefully, that helps.