Hospitalist Admit Billing

Question: A patient presents at the emergency room with a hip fracture. The orthopedic surgeon is called and he states that he cannot be there for two hours, and he then asks the hospitalist to admit the patient. The hospitalist does so. Here’s my question: Can the hospitalist perform and bill for the admission if the patient has no other medical reason to be admitted to the hospital other than the hip fracture? Also considering that the orthopedic surgeon will be billing a global CPT code for the hip repair?

Answer: There are a lot of variables here. First, there is no definitive answer because every payer interprets these things differently. Do you want the Medicare answer? If so, what carrier? That’s probably what you want to know.

The patient is going to get admitted anyway. In the normal course of events the orthopedic surgeon would have done an ED consult, billed it with a -57, and let the admit go as part of the global, assuming surgery was done. He later would have likely turfed medical management of the patient’s problems to the hospitalist anyway, which would have been a subsequent visit on that same day.

In this delayed scenario, if the orthopedic surgeon thinks the patient needs to be admitted and stabilized by the hospitalist, then that should be enough. The orthopedic surgeon will then show up and do the surgery - and bill globally.

Don’t try to make a science of this; you have to deal with these events as they unfold, rather than define or pigeonhole the coding for every configuration of events.

Bill Dacey, CPC, MBA, MHA, is principal in the Dacey Group, a consulting firm dedicated to coding, billing, documentation, and compliance concerns. Dacey is a PMCC-certified instructor and has been active in physician training for more than 20 years. He can be reached at billdacey@msn.com or physicianspractice@cmpmedica.com.

This question originally appeared in the July/August 2010 issue of Physicians Practice.