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Posted By angie on 02-25-2019, 07:45:53 in Ob-Gyn
a provider asked me this question. We can only bill a face to face encounter, but if we then see them again to admit them we can only bill one visit not both. secondly if they are OB patients and delivery in 24 hours we then can't bill admission. Can you take a look at this question and make sure I'm correct in what I'm telling them.


Provider question...........
- I'm wondering about billing for triage patients if we see someone in triage at the hospital and document a note.

- Is every triage visit where we see them & document billable (outside of the global fee)?
- What documentation is needed to bill? (full H&P vs progress note)?
- Do you have any idea how much insurance companies pay for a documented triage visit/assessment?

The hospital may be changing the requirements for MD's to see triage patients, so trying to present accurate info to the group about this.
Comments (1)
Posted By Melanie Witt on 02-26-2019, 15:45:31
For the most part, payers reimburse for triage if there is a complication, not for routine r/o labor visits at term. That said, if the provider sees the patient, and documents the visit, and selects the E/M code that is supported by the documentation (ie, admitted for observation, or seen and discharged during the triage that equates to an outpatient visit), then you might be reimbursed. If the only diagnosis is routine pregnancy, however, you will certainly have an issue with reimbursement. Hospital admission is included in all of the delivery services. So if the patient is admitted for possible labor and then goes on to deliver within 24 hours, that initial admission will not be paid. In order to pay for the admission the payer must have evidence that the patient was not admitted for possible delivery (eg,, early labor, bleeding, pre-eclampsia, severe nausea) or that the inpatient admission was entirely for a condition unrelated to pregnancy care (eg, patient develops pneumonia, patient has an MVA with injuries that require hospitalization). Insurance pays based on the CPT code reported, and in some cases the site of service. So if the patient is seen in L&D (which is not an ER room by the way for billing services) it would be outpatient hospital rather than office place of service which may mean lower reimbursement for say a level 3 E/M service in that setting.
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