Direct Admission from clinic

Post here your questions regarding auditing ,coding, documentation, and compliance. Also, join in on the conversation- help your fellow auditors and compliance professionals in the industry.

Moderators: Shannon DeConda, NAMAS Moderator

Post Reply
Posts: 76
Joined: Fri Jun 23, 2017 1:41 pm
Location: Multi-specialty Clinic

Tue Jan 02, 2018 2:35 pm

Can the visit from the clinic count as the Observation H & P for the hospital (99218-99220) or does the physician have to have a direct face-to-face after the admission to bill for this service?
User avatar
Site Admin
Posts: 434
Joined: Mon Apr 09, 2012 1:54 pm

Sat Jan 06, 2018 10:55 am

If the provider that saw the patient in the clinic, has the ability to see the patient in observation, and to admit them to observation, the documentation could be used to support the E/M, however if it is the only documentation then only the POS of clinic would be supported, so regular E/M services (99201-99215) would be used not observation codes.

If the provider does NOT have admitting privileges, then no, it cannot be used.

Your question has been answered by Omega Renne, CPC, CPCO, CPMA, CEMC, CIMC
Post Reply