Cardiology Coding Alert

Question: The cardiologist admitted a patient to observation on day 1 with chest pain (99220). On day 2 the patient was admitted with inpatient status. On day 3, the cardiologist discharged the patient (99238). Which code should I use for day 2?

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Answer: For day 2, when the cardiologist admitted the patient as an inpatient, choose an initial hospital visit code from 99221-99223 (Initial hospital care, per day, for the evaluation and management of a patient …).

Support: Medicare instructs: “If the patient is admitted to inpatient status from hospital outpatient observation care subsequent to the date of initiation of observation services, the physician must bill an initial hospital visit for the services provided on that date” (Medicare Claims Processing Manual, Chapter 12, 30.6.8.D).

Also remember the use of modifier AI for Medicare: “Physicians who provide an initial visit to a patient during inpatient hospital care that meets the minimum key component work and/or medical necessity requirements shall report an initial hospital care code (99221-99223). The principal physician of record shall append modifier ‘-AI’ (Principal Physician of Record) to the claim for the initial hospital care code. This modifier will identify the physician who oversees the patient’s care from all other physicians who may be furnishing specialty care” (Medicare Claims Processing Manual, Chapter 12, 30.6.9.1.F).