General Surgery Coding Alert

Question: My surgeon admitted a patient who presented to the emergency room late at night. Even though the patient was admitted before midnight, my physician didn't see her until a few hours later, which means the date of service for the hospital admission does not match the surgeon's first face-to-face encounter with the patient. Should I report 99222 with the first date of service?

Wisconsin Subscriber

Answer: No, you should report the appropriate initial hospital care code (99221-99223, Initial hospital care, per day, for the evaluation and management of a patient ...) with the date of service (DOS) when your surgeon saw the patient -- in this case, the second day.

Why: The DOS for the physician's E/M is the date when the physician provided the face-to-face inpatient encounter with the patient in the hospital. CPT Assistant (July 2007) supports this, stating "From the reporting physician perspective, the hospital admission services are reported on the date they are performed, which may not be the date of hospital admission."

Many coders get confused when reporting 99221- 99223 because they think these codes are "admission" codes. There is nothing in the code descriptors that mentions admission. Instead, the codes describe initial hospital care.

Since the patient was admitted from the emergency room, your DOS attached to 99221-99223 will not matchthe DOS on the hospital's claim. Sometimes this can trigger a denial from the payer. You should appeal any such denials.

Tip: If your surgeon had admitted the patient from your office but didn't see her as an inpatient until after midnight, you would be able to report both the office visit and the initial hospital care.