# Admit vs office visit



## TrishFLmom (Oct 14, 2013)

I know the question has been asked before but mine is a little different 
Physician see's the patient in the office and decides that the patient needs to go to the hospital. He dictates an office note indicating direct admit. He also dictates H&P on the hospital line but all through the note it states that the patient was seen in the clinic. Side note, patient was never seen by admitting physician in the hosptial. See excerpts below.

"I am admitting patient directly from pulmonary clinic today for acute illness. In the hospital his care will be assumed by Dr. xxx on the pulmonary service.
Admission orders and initial testing have been put in place, case has been discussed with Dr. xxx and patient is going to the hospital for admission now."

The physician is requesting 99222. Since the face-to-face took place in the office he can't bill for the admit...is this correct? How can you bill pos 21 when services took place in 11 or 22? 

Per CPT, “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 status in a hospital, office, nursing facility) all evaluation & 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 in the inpatient setting.” 

I would think the assumption is that the patient is seen in the hospital and that the above statement is simply stating not to bill both. Thank you in advance for your feedback.


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## km040186 (Oct 14, 2013)

Dont quote me but I'm pretty sure because the pt was seen in the office/clinic an was directly admitted the phyisican can bill only the Admit code (99222) if the same physican or someone from the same practice admitted him. If the pt was directly admitted but not seen by the same physican or same practice then the physican can bill for the office/clinic visit.

Not sure if this makes sense or this is what you were asking


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## TrishFLmom (Oct 14, 2013)

Sorry....no physician in the group saw this patient on dos in the hospital, only in the office.


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## debflutter (Oct 15, 2013)

*Straight from the CPT book*

"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, observations status 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."

Debi Miller, CPC, CEMC


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## TrishFLmom (Oct 15, 2013)

Thank you Debie. I did see that and posted that in my thread, however, I believe that statement assumes that the physician has ALSO seen the patient in the hospital in addition to the office......per my previous statement "how can you bill a pos 21 when the services took place in 11 or 22?"


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## cheermom68 (Oct 15, 2013)

In order to bill the Initial visit codes, the physician must have a face to face with the patient in the hospital.  Your doctor would just bill the office visit.  Doctor XXX (the doctor seeing the patient in the hospital) would bill the initial visit (99221-99223).


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