Cardiology Coding Alert

Question: Which E/M codes should I report for outpatient admissions? I need to know how to report situations in which all of the physician's work and time spent with the patient to admit him takes place on the date before the actual admit. Often, these are patients who aren't technically admitted by the hospital until shortly after midnight.

California Subscriber

Answer: You need to determine if the patient is being admitted to observation status or inpatient status, because this will impact the appropriate range of codes. You should report inpatient admissions with the applicable code from the 99221-99223 group. Choose the appropriate code for observation admissions from the 99218-99220 range.

Keep in mind that each inpatient admission code defines the service as "Initial hospital care, per day, for the evaluation and management of a patient," while observation admission codes describe the service as "Initial observation care, per day, for the evaluation and management of a patient." The difference in these code ranges is the amount of history, exam and medical decision-making the physician documented. The inpatient admission codes also have a time component that would apply if the physician spends more than half of his face-to-face/unit-floor time in counseling and/or coordination of care (and he clearly documents in the admit note the total time and the counseling/coordination time).

Because each of these code ranges defines the service as the "initial" care and further specifies that the code is "per day," you should not count any of the documentation prior to the day the patient was admitted.

 - You Be the Coder and Reader Questions were prepared with the assistance of Jim Collins, CHCC, CPC, president of Compliant MD Inc. and compliance manager for several cardiology groups around the country; and reviewed by Jerome Williams Jr. MD, FACC, a cardiologist with Mid Carolina Cardiology in Charlotte, N.C.