EM Coding Alert

Question: Can you use inpatient initial care codes 99221-99223 more than once in the same day if a different physician sees the patient?

South Carolina Subscriber

Answer: No. You can report a code from the 99221-99223 range (Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components …) range only once per day. You could, however, add up all of the documentation for that day to determine the level of service that would fit best based on that collective documentation by the physician. You use these codes to report the first hospital inpatient encounter with a patient for Medicare patients. For the other payers not following Medicare’s guidelines, only the admitting physician would use this code set (for Medicare, the admitting physician adds the AI modifier [Principal Physician of Record]) As with the other E/M codes, you will decide the appropriate level of the initial hospital care code based upon history, examination, and medical decision making.

Although only the admitting physician (for non-Medicare patients) can report initial inpatient care with codes 99221-99223, other physicians who have initial inpatient encounters do have code options for their services. In these cases, you can look to initial inpatient consultation codes 99251-99255 (Inpatient consultationfor a new or established patient, which requires these 3 key components …) or subsequent hospital care codes 99231-99233 (Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components …).

Remember: You cannot report another E/M service along with codes 99221-99223, but if the physician sees the patient multiple times during that first day, all of the documentation would be used toward the level of service you select.