It’s an all too common scenario: a patient presents to a facility, stays for treatment, gets discharged, and quickly returns complaining of the same or similar issues. Because of the constant back and forth, it can become tricky to determine how to properly bill for the various encounters.
Typically, the general rule is to bill each encounter separately as long as the patient returns on a different day. There are, however, a few exceptions. If the patient returns on the same day for a problem related to the first admission, then billing for the two admissions would be combined into one. The same goes for if the gap between the admissions is a planned leave of absence and it was always intended for the patient to return the second time around.
But what if the patient is discharged from the first admission only to return a few days later with the same problem? In an example provided by RACmonitor, a patient presents with pneumonia, is treated and released, then returns the next day with difficulty breathing and is diagnosed with a pleural effusion. Many healthcare professionals would consider this a mistake and document the two admissions as a single visit, believing that receiving two DRG payments would be unfair.
Unfortunately, CMS offers no official guidelines allowing hospitals to do such a thing; though it is not expressly forbidden, the proper response is technically to bill each admission separately. But there is a sizable consensus among many professionals that this course of action is irresponsible, leading some to find alternate solutions. Some have started billing the two admissions as if it was planned that way all along, and others have tried to use no-pay 110 claims in order to fix the problem (though this type is code is difficult to use unless the hospital undoubtedly caused the readmission, such as by discharging the patient with the wrong medication). Neither of these is a perfect solution, but hopefully CMS will one day update their guidelines in order to cover such scenarios.