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Reader Question: Think Initial Hospital Care Codes Are Just for Admits? Think Again

Question: A badly uncontrolled, type II diabetic presented to our office with complications that warranted admission to the hospital. One of our endocrinologists examined the patient in the office, sent him to the hospital for admission, and wrote up all the necessary admission paper work. The following morning, the same endocrinologist visited the patient at the hospital to render inpatient care. Should we bill an initial hospital care code for the admit and a subsequent hospital care code for the inpatient care the following day?

Georgia Subscriber

Answer: No. A popular misconception among physicians and coders is that initial hospital care codes (99221-99223) are for patient admission - but they are not. To report 99221-99223, the physician must render face-to-face initial hospital care to the inpatient. Just an admission does not merit these codes.

So in your case, you should report the first day's services (office exam and admission decision) with an E/M code, such as 99213 or 99214. Chances are the admission may increase your level of service because the physician engaged in complicated decision-making. However, remember that documentation must guide your level of service.

For the second day's services (first inpatient encounter) you should report the appropriate-level initial hospital care code (99221-99223). If your endocrinologist continues to treat the patient in the hospital, you should report subsequent visits with subsequent hospital care codes (99231-99233).

Helpful hint: If your endocrinologist had admitted the patient in the office and then visited the patient in the hospital on the same day, you could have reported an initial hospital care code. When the physician performs an admission and initial hospital care on the same day, you must report one initial hospital care code to recoup for all the physician's services that day.

Add up the components: If the physician has multiple encounters with the patient on the day of admission and initial hospital care, you should add up the components (exam, history and medical decision-making) of each encounter to determine the appropriate level of service for the initial hospital care code.

- Published on 2004-10-19

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