Neurology & Pain Management Coding Alert

Question: If I see a patient in the office and admit him or her to the hospital, I still have to go to the hospital and see the patient there, according to Medicare regulations. However, I can't bill for two E/M services on the same day. How do I get paid for both services?

Michigan Subscriber

Answer: To bill for an inpatient admission (99221-99223), Medicare requires that you provide initial inpatient service to the patient at the hospital and document what you provided. You cannot bill for two E/M services on the same day. However, you don't have to lose reimbursement for the services. You can combine the office visit (99201-99215) and the hospital inpatient admission and choose your level of E/M service based on that. In many cases, the inpatient admission has higher reimbursement than the office visit.
 
For example, your combined services may meet the requirements for a level-three inpatient admission, resulting in higher reimbursement than a level-two office visit. When you report the hospital admission, document the work performed in the office.
 
If you have not reported an inpatient admission for a patient and then bill for subsequent hospital care, you could raise a red flag with Medicare. The rule of thumb is to combine the two same-day services and then determine the E/M level. If you only bill for an office visit and not the hospital admission, you could also be losing money.

Clinical and coding expertise for You Be the Coder and Reader Questions provided by Catherine Brink, president, HealthCare Resource Management Inc., Spring Lake, N.J.; Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center at Shadyside, and clinical associate professor in the department of neurology, University of Pittsburgh School of Medicine; Laureen Jandreop, OTR, CPC, CCS-P, CPC-H, CCS, owner and CPC trainer for A+ Medical Management and Education in Absecon, N.J.; and Joseph R. Batte, CFE, former supervisory special agent for the OIG and an independent compliance consultant, Marco Island, Fla.