When is (Direct Admit) G0379 appropriate with relationship to "physician in the community"

There seems to always be some conversation going around about when to charge the Direct Admit to OBS charge.  I think the billing manual is vague on it's description/definition of "physician in the community".  Is this ANY type of referral source where a physician is making a phone call to my in house docs for acceptance?  i.e. Free standing ED or UC, that is not a dept of the hospital, has a doc that calls my Hospitalist to accept a patient for observation services.  Doe that scenario fit the "physician in the community" criteria???  None of the docs or entities that encountered the patient prior to my admit to OBS have any billing relationship to us.  Direct Admit charge or no direct admit charge????  


  • This is such a good question and I will presenting the answer at the Revenue Intergrity Symposium in fall. Will you be there?

  • I will not be able to attend this year so I am reaching out to get some thoughts on the matter as we are in discussion right now.  
  • The answer, at least according to WPS, one of the MACs, is no. You cannot use G0379 for that patient. I also asked Palmetto and Noridian at the CMS Complinace Conference and the answer was "was is G0379?"
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