Hospital visit billing in Alberta — inpatient rounds and admission codes

Billing for hospital work is one of the most variable areas of SOMB, and one of the most commonly underbilled. The distinction between visit types, the role of complexity, and the rules around same-day billing all affect how much you can legitimately claim.

This page covers the SOMB framework for hospital visit billing, the main code categories, and the errors that result in lost revenue or audit exposure.

Hospital visit code categories in SOMB

Alberta SOMB organizes hospital visit codes by visit type and clinical role:

Admission visit billing

The admission visit is typically the highest-value hospital visit code. To bill it correctly:

• The physician must personally examine the patient and document a history, physical, assessment, and plan
• A third-party admission (where another physician admits and you assess later) typically qualifies for a subsequent visit, not an admission code
• Complexity matters — SOMB distinguishes between straightforward and complex admissions for many specialties

Daily rounds (subsequent visit) billing

Subsequent visits are billed for each day a physician sees an admitted patient. Key rules:

• Only one subsequent visit per patient per day is billable by a given physician, regardless of how many times they see the patient
• If multiple physicians from the same group see the patient on the same day, only one can bill a subsequent visit for that day — co-management rules apply
• Brief bedside assessments that do not involve a full re-evaluation may not qualify for the full subsequent visit code

Discharge billing

Discharge visits are frequently missed or under-billed. They are separate from the final subsequent visit and involve:

• Coordination of discharge planning
• Patient and family education
• Prescriptions and follow-up instructions
• Communication with community providers

If the physician who discharges the patient is different from the admitting physician, the discharging physician bills the discharge visit.

Common hospital visit billing mistakes

1. Billing a subsequent visit on the day of admission

On the day of admission, the appropriate code is the admission visit — not both an admission and a subsequent visit. Billing both on the same day will typically result in a claim rejection or automatic reduction.

2. Missing discharge billing

Many physicians forget to bill separately for discharge. Since discharge often happens early in the morning or at the end of a busy shift, it gets absorbed into the subsequent visit — leaving money on the table.

3. Multiple physicians billing the same visit type on the same day

In teaching hospitals and group practices, more than one physician may assess the same patient on a given day. SOMB limits who can bill for each visit type per day. The rules differ for supervising vs. teaching vs. covering roles.

4. Underbilling complex admissions

Admissions involving multiple comorbidities, complex medication management, or multidisciplinary coordination often qualify for higher-complexity codes. Defaulting to the standard admission code when a complex one applies is a systematic revenue leak.

5. Not billing after-hours premiums for urgent hospital visits

Urgent calls to assess deteriorating inpatients during the evening or overnight qualify for after-hours premiums. These are frequently missed when the billing is done the following day.