Coding Corner - 2nd Quarter 2010
Admission and Readmission (Same Day):
KFMC wants to provide and remind providers of Kansas Medical Assistance Program (KMAP) direction surrounding admissions and readmission. The following is instruction taken directly for the KMAP Hospital Provider Manual located on the web at https://www.kmap-state-ks.us/public/providermanuals.asp.
Please reference the Hospital Manual, Section 7020 page 7-13.
Admission and Readmission (Same Day):
Admission
An inpatient admission starts when the physician writes an order for an inpatient admission. It is not considered inpatient until that order has been written. Documented verbal admission orders are considered the same as written orders.
· Scenario #1: A patient is sent to the medical floor on September 23 at 11:00 p.m. The physician writes an order to admit the patient on September 24 at 3:00 a.m. According to KMAP, the inpatient admission starts on September 24 at 3:00 a.m.
· Scenario #2: A physician writes an order for a patient to be admitted inpatient on September 23 at 11:00 p.m. The patient arrives on the medical floor on September 24 at 3:00 a.m. According to KMAP, the inpatient admission starts on September 23 at 11:00 p.m.
· Scenario #3: A physician contacts a hospital on September 23 at 11:00 p.m. about a direct admission and gives a verbal order for admission once the patient arrives at the hospital. The patient arrives at the hospital on September 24 at 3:00 a.m. According to KMAP, the inpatient admission starts on September 24 at 3:00 a.m.
Readmission (Same Day)
When a patient is discharged or transferred from an inpatient hospital and is readmitted to the same inpatient hospital on the same day for symptoms related to or for evaluation and management of the prior stay’s medical condition, hospitals must adjust the original claim generated by the original stay by combining the original and subsequent stay onto a single claim.
When a patient is discharged or transferred from an inpatient hospital and is readmitted to the same inpatient hospital on the same day for symptoms unrelated to and not for evaluation and management of the prior stay’s medical condition, hospitals must bill for two separate stays on two separate claims.
For More Information
Call 1-800-432-0770, or contact us by email.