Gastroenterology Coding Alert

Question: Following an in-office exam on day one, our urologist sent a patient to the hospital with copies of his admission orders. The urologist didn't go to the hospital that day, and his partner, a gastroenterologist, saw the patient in the hospital on day two. How should I report this?

Wisconsin Subscriber

Answer: In this scenario, you should bill an office visit code (99201-99215) for the urologist's services on day one. For the gastroenterologist's services on day two, you should report an initial hospital care code (99221-99223), as long as the physician performs and documents the level of care necessary to bill that service.
 
Because the urologist and the gastroenterologist are in a group practice and, presumably, bill under the same group identification number, most payers will treat them as interchangeable, which allows the group to bill the gastroenterologist's service as initial hospital care, even though the urologist may be the admitting physician of record.
 
Even if the gastroenterologist doesn't perform and document the care level necessary to bill for initial hospital care, he may still get to report 99221 (Initial hospital care, per day, for the evaluation and management of a patient -).
 
When a physician performs a visit that meets the definition of a level-five office visit prior to the admission date and then on the admission day performs initial hospital care that involves less than a comprehensive history and physical, he should report the office visit that reflects the services he furnished and also report the lowest-level initial hospital care code (99221) for the initial hospital admission, according to the Medicare Carriers Manual section 15505.1.E.