This article and the related comments are for educational and discussion purposes. They do not establish the standard of care in every patient\u2019s situation. In each patient\u2019s situation, the treating physician or other medical professionals must exercise their professional judgment. Similarly, these materials are not medical advice to patients, who must consult with their own physician or other medical professional. <\/p><\/div><\/div>\n\n\n\n
Every hospitalist has had a patient leave AMA from the hospital at some point. What to bill depends on the service provided to the patient on the date of service that the patient left AMA. There are three main scenarios:<\/p>\n\n\n\n
When a hospitalist provides a face-to-face initial or subsequent visit service to a patient who later leaves AMA on the same day, the provider should document and bill for the initial or subsequent service provided earlier in the day. For example, if the hospitalist admitted the patient with an initial visit service, the provider should complete an H&P and bill the initial visit code. If the provider provides a follow up visit, then he should bill a subsequent visit code and complete a progress note. Additionally, for patient safety and as a courtesy to the referring physician and colleagues who may have to re-admit the patient down the road, the hospitalist should add an addendum to the original note for the day outlining any pertinent hospital course, lab results, study findings, etc. If the patient leaves on any day other than the admission day, the provider will also be responsible for completing the DCS for the patient\u2019s admission. <\/p>\n\n\n\n
When a patient leaves AMA and the physician\/NPP has a face-to-face encounter with the patient and<\/strong> provides discharge services to the patient, the provider should bill a DC code and complete a DCS. The patient is still leaving AMA, but when discharge service work is provided (discussion about risks of leaving AMA, filling out discharge prescriptions and orders, completing a DCS, etc.) the correct code is the DC code. Completing a DCS alone without any other discharge service work does not constitute a DC service and should not be billed using a DC code. <\/p>\n\n\n\nFinally, when a patient leaves AMA, but Apogee has not had a face-to-face encounter with the patient, the provider cannot bill for a service that day. The provider on service will still have to complete a discharge summary with the final diagnoses, hospital course and any other pertinent information, but this is a non-billable service if there wasn\u2019t a face-to-face encounter with the patient. <\/p>\n","protected":false},"excerpt":{"rendered":"
Every hospitalist has had a patient leave AMA from the hospital at some point. What to bill depends on the service provided to the patient on the date of service that the patient left AMA. 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