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Inpatient vs Outpatient Hospital Care

Fri, 09/13/2019 - 13:30
Good Afternoon. I was recently admitted to the hospital (outpatient) via the ER following a tonic clonic seizure in my backyard. The Hospitalist on duty determined that the stay would be considered outpatient and not inpatient. He noted in my chart that the admitting and discharge diagnosis was fainting/syncope, but this dx has since been amended to an epileptic event. What part of a tonic clonic seizure and resulting EEG, MRI, carotid ultrasound, EKG, and radiology testing would help classify the event as something that should have been considered inpatient? I understand that there are many factors to consider when the Hospitalist decides whether or not to classify as inpatient versus outpatient, but what would be a factor that I could present to him to consider amending the treatment to inpatient instead? I cannot pay a $19k medical bill not covered by my commercial insurance because it was coded outpatient. Thank you!

Comments

I don’t have any advice on

Submitted by Patriotrehab on Sat, 2019-09-14 - 09:55
I don’t have any advice on what to do for the medical coding and billing purposes, but maybe someone else can help you with that. All of the tests help in diagnosis, but the EEG is what they rely on to determine if there is abnormal electrical activity in the brain. If they found that, the doctor would have certainly amended the diagnosis right away as they did. If they didn’t find that, then there could be some other information such as in the MRI. You are best to wait until you speak with your treatment team, possibly including a new doctor (neurologist) as to what they actually found in the results though so that you can have a complete understanding as everyone is different when it comes to cause of epilepsy and that also affects how they diagnosis it.

Hi Anne with an E,  Thanks so

Submitted by Anonymous on Mon, 2019-09-16 - 09:36
Hi Anne with an E,  Thanks so much for posting, we understand this must have been very scary and frustrating to experience. It may be helpful to contact the hospital you were seen at and your insurance company, to see if they can adjust the coding for you. For information regarding insurance appeals please, visit: www.patientadvocate.orgAnd for information regarding our patient assistance programs please visit: https://www.epilepsy.com/living-epilepsy/247-helpline/patient-assistance You may also contact our Epilepsy and Seizures 24/7 Helpline:1-800-332-1000, contactus@efa.org, where a trained information specialist can connect you to resources,provide referrals and additional support.epilepsy.com/helpline   

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