Inpatient to outpatient

[J ROD]

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If I see a patient while working inpatient in the ED and admit and do a H&P. On discharge, the patient is sent to my outpatient clinic. I see him there. Is that a follow up note or a new evaluation as an outpatient? About to start seeing outpatient and really would appreciate clarification on this before I get rolling. Thanks.

 

[hamstergang]

If I see a patient while working inpatient in the ED and admit and do a H&P. On discharge, the patient is sent to my outpatient clinic. I see him there. Is that a follow up note or a new evaluation as an outpatient? About to start seeing outpatient and really would appreciate clarification on this before I get rolling. Thanks.

I personally do an eval note because I want an outpatient eval note somewhere for when it's looked for later. But I'd bill as a follow up. I might aim for it to be a 1 hour appointment (typically 90 minute evals and 30 minute follow ups).

 

[allantois]

I don't think insurance will have a problem with you billing for a new patient code (as hospital codes are different and you would not have billed the same code when seeing them inpatient).

 

[comp1]

Yeah, it's not the same code. I would think you could do an outpatient intake. I mean almost by definition this is going to be a complicated patient encounter that probably justifies the extra time.

 

[deleted1100659]

My understanding is it would be an intake note rather than progress note given the change in setting. Im fairly certain of this.

 

[J ROD]

How does 90792 code work into this? Because both can be used in and outpatient.

 

[splik]

How does 90792 code work into this? Because both can be used in and outpatient.

You would typically do an intake note (but you could also do as a f/u note) but you cannot bill the new pt E&M codes if you saw the pt before even in a different setting. You can however use 90792.

 

[J ROD]

You would typically do an intake note (but you could also do as a f/u note) but you cannot bill the new pt E&M codes if you saw the pt before even in a different setting. You can however use 90792.

So I could do another 90792 if I did it inpatient and two weeks later do it again outpatient?

 

[Psych19]

I don't think insurance will have a problem with you billing for a new patient code (as hospital codes are different and you would not have billed the same code when seeing them inpatient).

I think CMS is very explicit that you're not supposed to use new patient outpatient codes (e.g. 99203, 99204, 99205) if you've seen the patient in any setting (inpatient or outpatient) in the past 3 years. Technically you're also not supposed to use these codes if the patient was seen by anyone in your "group" in the past 3 years.

That said, I bet other docs do this all the time and never get in trouble. I see one doc in my group do this frequently, but he tends to underbill routinely anyways, so I doubt he would ever get audited.

Insurance is going to be more effective in clawing back money by going after 99214's and 99215's, and trying to get providers to downcode to 99213, than they will be in trying to catch the one time providers are billing 99204 or 99205 when they should have billed 99214 or 99215.

So I could do another 90792 if I did it inpatient and two weeks later do it again outpatient?

My understanding is you're allowed to bill 90792 more than once even in a relatively short period of time if an intake must occur over several encounters. I don't think it would be that hard to justify billing a 90792 for the first time you see the patient in the office, as long as you're documenting an intake note and you're spending an "intake-worthy" amount of time on this encounter.

 

[Sushirolls]

90792 will be the solution for the outpatient evaluation. Bill that.

 

[nexus73]

either use a longer appointment and bill 99215 99417

or use 90792.