Gastroenterology Coding Alert

Question: Thanks for your article last month on inpatient coding. I have a follow-up question: If we see a Medicare patient in the emergency department (ED) and then admit that patient to the hospital, can we report both an ED code and an inpatient code?

Alabama Subscriber

Answer: No, in this situation, you will include everything the gastroenterologist did on that date as part of the admission. Therefore, you would not report an ED code (99281-99285) at all, but you would instead use an inpatient code from the 99221-99223 (Initial hospital care, per day, for the evaluation and management of a patient …) series.

CMS is very clear about that fact that you cannot report the ED code along with the inpatient code. “Contractors pay for an initial hospital care service or an initial inpatient consultation if a physician sees his/her patient in the emergency room and decides to admit the person to the hospital,” CMS says in chapter 12 of the Medicare Claims Processing Manual. “They do not pay for both E/M services. Also, they do not pay for an emergency department visit by the same physician on the same date of service. When the patient is admitted to the hospital via another site of service (e.g., hospital emergency department, physician’s office, nursing facility), all services provided by the physician in conjunction with that admission are considered part of the initial hospital care when performed on the same date as the admission.”

Therefore, you should combine the work from both visits to come up with the appropriate inpatient code.