# hawkinsj



## hawkinsj (Dec 2, 2011)

Patient admitted to hospital day one  observation 99220  H&P dictated
Patient changed to in patient day two now high risk 99223 entered for day two

Does the provider HAVE to dictate a new H&P on day two OR can there just be an addendum dictated to day one document.  

I need proof of your position.  I can find nothing that says what must be done other than some random articles.

Case management requires an order saying 'patient status changed to in patient and the reason why'.  

Thanks, 
Janet


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## ajs (Dec 2, 2011)

hawkinsj said:


> Patient admitted to hospital day one  observation 99220  H&P dictated
> Patient changed to in patient day two now high risk 99223 entered for day two
> 
> Does the provider HAVE to dictate a new H&P on day two OR can there just be an addendum dictated to day one document.
> ...



The only thing I could find was in the CPT book page 14 the guidelines prior to the codes for Initial Hospital Care states:
 "When the patient is admitted to the hospital as an inpatient in the course of an encounter in another site of service (eg, hospital emergency department, observation staus in a hospital, physician's office, nursing facility) all evaluation and management services provided by that physician in conjunction with that admission are considered part of the initial hospital care when performed on the same date as the admission.  The inpatient care level of service reported by the admitting physician should include the services related to the admission he/she provided in the other sites of service as well as the inpatient setting."  Since you said these were two different dates of service, this probably does not apply.  

There is no other guideline that relates to the need for separate H&P, but that may fall under specific hospital guidelines.  Frequently hospitals have their own rules about what they want documented and when it needs to be done.


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## FTessaBartels (Dec 2, 2011)

*H&P does NOT equal Initial Hospital Visit*

The H&P is a requirement of the hospital.  It is - almost exclusively - what the physician uses to document the initial hospital visit.  However, it does NOT have to be used as the official documentation.

So to answer your initial question ... 
1) The HOSPITAL* may *allow the physician to simply order the change in status and place an addendum on the H&P (a hospital-required form). 

2) If the physician wants to be able to BILL an Initial Hospital Visit on day two - s/he must document a face-to-face visit that meets the documentaiton standards of 99221-99223.  And NO, you cannot use "yesterday's" note (except for the ROS & PMFSH) ... new complaint, new HPI, new exam, new assessment/plan. 

Hope that helps.

F Tessa Bartels, CPC, CEMC


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