April Coding Q&A

Members & Publications


April 24, 2017

NEW! Got coding questions? Your Academy has the answers. Each month we will feature a member’s question with an answer provided by AAPM&R’s Reimbursement and Policy Review Committee (RPRC).

Q: How do we bill if a Medicare patient is transferred off the inpatient rehab unit to inpatient (ICU for example) and then transferred back to the rehab unit? Should there be a discharge and a new admission?

A: Yes, you will bill for a discharge and then for a new admission back to inpatient rehab unless it is within 3 days. If the patient returns prior to the third midnight, Medicare considers this an interruption of care rather than a discharge and you should continue to bill as if the patient never left. If the acute hospital inpatient stay lasts past the third midnight, the patient will need to be considered for admission just as any other patient referred for inpatient rehabilitation. This includes a new pre-admission assessment, which includes updated medical and functional information. If the patient is appropriate for readmission to inpatient rehab, a new H&P, post-admission physician evaluation (which may or may not be included in the H&P) and individualized plan of care are required for the new inpatient rehabilitation facility visit. 

Commercial insurers typically consider this differently and consider the patient to have been discharged from inpatient rehabilitation either if they are admitted to an acute care hospital or if they are out of the rehabilitation hospital past a single mid-night, regardless of the duration of the interruption. Clinicians should check with their individual carrier and discuss with the rehabilitation hospital’s administration for clarification about how an individual case will be handled. 

Find additional resources related to reimbursement here. Do you have a coding or billing question? Contact AAPM&R at codingquestions@aapmr.org for assistance. 

Accurate coding is the responsibility of the provider. This article is intended only as a resource to assist in the billing process.

Legislation Introduced to Alleviate Impact of Conversion Factor Cut for 2021

Nov 09, 2020

Last month, two bills were introduced in the House proposing solutions to the estimated 10.6% Physician Fee Schedule conversion factor cut expected to go into effect January 1, 2021.  The bills offer some relief to the cut, but do not reflect a comprehensive or long-term solution.  AAPM&R has therefore chosen to remain neutral regarding these bills. 

Your Academy continues to advocate for a permanent solution to the conversion factor cut while maintaining the important payment increases to office and outpatient evaluation and management services.