# When to code initial care?



## cnramsey (Sep 29, 2010)

If a patient comes in to the ED on 9/27 and the PA working the ED admits the patient to the hospital. The hospital will only bill out the ED visit for 9/27 for the the PA 99281-99285.  My physician doesn't come in until the next morning 9/28. Would I bill out initial visit or subsequential visit on this day?

Thanks 
Nichole


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## LTibbetts (Oct 1, 2010)

Actually, in this case, I wouldn't charge for the PA's ER visit at all, according to the coding guidelines for inpatient intial hospital care codes. Go to your CPT book and read the paragraphs above the 99221 code to see what I mean. I posted it below for you, too. Unless you are a critical care hospital, you should only bill for the initial hospital. Citical care hospitals would bill for both.

_Inpatient hospital care E/M codes
      CPT Assistant, April 2003 Pages: 26-27 Category: Coding Consultation 
      Related Information 

Evaluation and Management Services/Initial Hospital Care 

The admitting physician may report a code from the Inpatient Hospital Care series, 99221-99223. 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, 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 in the inpatient setting. 

CPT Assistant © Copyright 1990-2010, American Medical Association. All rights reserved. _ 


I know it sounds confusing because the PA is not the admitting doc, but since they are both part of the same practice, and it was all considered as the same encounter, it doesn't matter. It is considered to be the same. Hope this helps.


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## cnramsey (Oct 4, 2010)

*Charging Initial Inpatient Visits*

We are a Critical Access hosp. My problem is I have always coded the initial visit when the provider sees the patient for the first time in the hosp. But others will only code the initial if the provider dictates a full H&P. If they don't they are saying that first visit has to be a subsequent visit. So I'm a little confused want to make sure I'm doing the correctly. 

Nichole


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## LTibbetts (Oct 4, 2010)

wow, that does sound a little confusing Usually, where I work, whoever admits the patient is the one who does the H&P, so it is never a problem for us here. Does the admitting PA ever dictate the H&P when they admit patients? Then the next days visit _would_ be a subsequent visit.
If not, why don't they? That would sure make it easier for all of you and it seems that the admitting physician, no matter if it is a PA or Doc, should always be the one to dictate an H&P upon admit.


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## cnramsey (Oct 6, 2010)

*When to charge Inpatient Admit*

The ED provider dictates an Emergency Room Report with the Plan Statingatient will be admitted for Inpatient for eg pain control to Acute Care in stable condition to the care of Dr Frank. Thats when Dr Frank will see the patient the next day depending on the time this all happened. 

Nichole


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