# 99214 versus 99221



## dwaldman (Sep 10, 2010)

Comments: she has been having headaches, malaise and dizziness for a month she was treated for migraines by neurologist but there was no resolution now her symptoms are worse she is off balance, has fever and numbness of her hands and feet she feels weak 
at this time i will obtain BRAIN MRI / MRA / COW TO RULED ANY INTRACRANIAL PROCESS INCLUDING INFECTION, ISCHEMIA ,EMBOLISM ALSO ANY OTHER STRUCTURAL MASS EFFECT OR MIDLINE SHIFT
- SHE WILL BE ADMITTED TO THE HOSPITAL 
___________________________________________________

Medicare Patient comes in for a schedule visit in the physician's office place service 11. The doctor I work with decided to admit the patient to the hospital. If he admited the patient to the hospital, but did not see the patient on the floor once they were admitted, how would I bill this. He has 99214. I am wondering if this should be 99221 with place of service 11 since the actual visit was in office setting, stay with 99214, or bill 99221 for the second day for initial hospital care, but for the second day the patient was discharged. Or bill the first day as 99221 with place of service 21. I looked at transmital 1875 but could not find my answer. Any help would be appreciated.


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## Anita Johnson (Sep 12, 2010)

*99221 if he meets the criteria*

Hi. I dont see 4 elements of HPI to qualify for the 99214, however, that point is moot. If your provider admitted the patient on the same day as the office visit, all of the office services are included in the hospital admit code. You can bill the 99221 with the modifier "AI" for that date of serivce. The seond day would be billed with a 99231-3 depending on the level of service. In this case, you may want to consider the discharge day code instead if I understand your note correctly. Good luck. Anita Johnson, CPC (soon to be CEMC)

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Comments: she has been having headaches, malaise and dizziness for a month she was treated for migraines by neurologist but there was no resolution now her symptoms are worse she is off balance, has fever and numbness of her hands and feet she feels weak 
at this time i will obtain BRAIN MRI / MRA / COW TO RULED ANY INTRACRANIAL PROCESS INCLUDING INFECTION, ISCHEMIA ,EMBOLISM ALSO ANY OTHER STRUCTURAL MASS EFFECT OR MIDLINE SHIFT
- SHE WILL BE ADMITTED TO THE HOSPITAL 
__________________________________________________ _

Medicare Patient comes in for a schedule visit in the physician's office place service 11. The doctor I work with decided to admit the patient to the hospital. If he admited the patient to the hospital, but did not see the patient on the floor once they were admitted, how would I bill this. He has 99214. I am wondering if this should be 99221 with place of service 11 since the actual visit was in office setting, stay with 99214, or bill 99221 for the second day for initial hospital care, but for the second day the patient was discharged. Or bill the first day as 99221 with place of service 21. I looked at transmital 1875 but could not find my answer. Any help would be appreciated.


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## cheermom68 (Sep 13, 2010)

*99221*

You are only allowed to bill the 99221 Initial hospital encounter if the MD actually saw the patient in the hospital that day, so if not, you would be limited to 99212-99215 depending on documentation.  The initial hospital encounter codes are restricted to the first actual visit in the hospital by the provider.


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