Inpatient Facility Coding & Compliance Alert

Question: We have several patients that we see in the office before they are admitted to the hospital later that same afternoon. Can we bill for the office visit and the first day of admission or do we just need to bill for the hospital stay? 

Illinois Subscriber

Answer: We need to focus on when your physician saw the patient in the hospital.

Same day: In the case of two face-to-face same day visits, you should use only the initial hospital care code (99221-99223). Since the 99221-99223 code will include the HEM provided in the office, you will have a higher level of initial hospital care than if you were considering the hospital services alone.

Different days: If the office visit and admission is on day 1, and the first face-to-face initial hospital care on day 2, charge the office visit (99201-99215) on day 1 and the initial hospital care (99221-99223) on day 2.