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. However, 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?


Texas Subscriber


Answer: The doctor is the person who decides when the patient needs to be admitted to inpatient status. If the doctor gave orders for the patient to be directly admitted to inpatient status, the hospital should retroactively say that the patient was in observation status. You may need to address this with your hospital. The genesis for this concern may be the fact that many patients require preauthorization for inpatient services.

You should not bill an admission (codes 99221-99223) unless your cardiologist actually saw the patient on that day. If your doctor gave orders for his patient to be admitted on the 18th but never saw him in that setting until the 19th, you should report the initial hospital care codes (99221-99223) on the 19th.