Last Modified: 3/15/2018 Location: FL, PR, USVI Business: Part A, Part B
Only one initial service covered on admission to hospital
Q. If a patient is seen in the emergency department, then admitted to the hospital, how should this be billed?
A. As stated in the CMS internet-only manual:
A/B MACs (B) pay for an initial hospital care service if a physician sees a patient in the emergency room and decides to admit the person to the hospital. They do not pay for both E/M services. Also, they do not pay for an emergency department visit by the same physician on the same date of service. When the patient is admitted to the hospital via another site of service (e.g., hospital emergency department, physician’s office, nursing facility), all services provided by the physician in conjunction with that admission are considered part of the initial hospital care when performed on the same date as the admission.
Source: CMS internet-only manual (IOM), Publication 100-04 Medicare Claims Processing Manual, Chapter 12, Section 188.8.131.52
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