Health Information Management

Q&A: We included a procedure on an inpatient claim before the patient was admitted

APCs Insider, May 15, 2015

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Q: We erroneously included a surgical inpatient-only procedure on an inpatient Medicare claim and don’t know how to handle this. The physician performed the procedure the day before the patient was admitted as an inpatient and our medical review staff stated it was related to the inpatient admission. What is the best way to handle this?
A: Actually, this is now permissible reporting according to Transmittal 3217. CMS revised billing instructions related to inpatient-only procedures that are performed as an outpatient procedure when the procedure happens within the three-day payment window.
If the inpatient-only procedure is performed on the day of admission as an inpatient, or during the three calendar days before the admission, and is deemed to be related to the inpatient admission, then the procedure can be bundled into the inpatient admission. This became effective April 1. CMS has updated the Claims Processing Manual, chapter 4, sections 10.12 and 180.7, to reflect the change in payment policy.
Editor’s note: Denise Williams, RN, CPC-H, seniorvice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Fort Lauderdale, Florida, answered this question.

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