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Cardiology Coding Alert

READER QUESTIONS:

Same Specialty, Same Day, Don't Code

Published on Sun Jan 01, 2006

Question: We have a "moonlighter" cardiologist who will admit a patient at 2 a.m. for one of the doctors off-call, and when that doctor returns to call at 7 a.m., he will then see his patient. The first cardiologist reported an admit or consult. Because this is technically the same day, what should the second cardiologist bill?


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Answer: If both cardiologists are in the same group and visit the patient for the same diagnosis, the second physician cannot submit a claim. The rules state that you cannot report for the same specialty on the same day for the same patient.

CPT illustrates that the code definitions for the admit codes (99221-99223) are "per day." In other words, these codes include all of the care provided on that calendar date. You Be the Coder and Reader Questions were prepared with the assistance of Jim Collins, ACS-CA, CHCC, CPC, CEO of the Cardiology Coalition 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.
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