Cardiology Coding Alert

Question: My cardiologist admitted a patient on the 18th and then saw him on the 19th. Then he did a TEE, echo and left heart cath on the 20th. But the hospital claims the patient was in fact in the emergency department on the 18th and was in observation status on the 19th and was not officially admitted until the 20th. How should I code this? New Mexico Subscriber
Answer: The doctor is the person who decides when to admit the patient to inpatient status. If the doctor gave orders for the patient to be directly admitted to inpatient status, the hospital should not retroactively say that the patient was in observation status. You may need to address this with your hospital staff. The genesis for this concern may be the fact that many patients require preauthorization for inpatient services. It may also have to do with the considerable reimbursement variances in hospital payment based on the place of service -- regardless of the intensity of services provided.

You should not bill an admission (99221-99223, Initial hospital care, per day, for the E/M of a patient ...) unless your cardiologist saw the patient on that day. If your doctor gave orders for the hospital to admit his patient on the 18th but never saw him in that setting until the 19th, you should report the initial hospital care code (99221-99223) on the 19th.