Neurosurgery Coding Alert

Question: When our neurosurgeon admits a patient to the hospital after hours from the emergency department (ED), how should I code her services?


California Subscriber


Answer: Usually, if the neurosurgeon performs the ED visit and admission on the same date, you should combine all services that the physician performs and documents in the admission code (99221-99223, Initial hospital care, per day, for the evaluation and management of a patient ...). However, you may bill separate charges using modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) if the two encounters are separate and distinct.
 
CPT considers all E/M services related to a single episode of illness that a physician provides on the same date in another site of service part of the initial hospital care.
 
So, when your neurosurgeon performs same-day outpatient and inpatient services, you should include the ED work in the initial hospital care level.

Watch out: If the physician performs services on different dates, you should bill each service. For example, a neurosurgeon treats an ED patient at 11 p.m., sends him home, but then admits the patient the next morning.

Because the services occur on different dates and represent different episodes of care, you should bill the ED service and the admission (as long as the separate encounters are medically necessary). Report the ED visit with 99281-99285 (Emergency department visit for the evaluation and management of a patient ...) and the admission as 99221-99223.

Be careful: Don't bill an ED visit and admission unless the neurosurgeon performs both services. If the ED physician treats the patient but the neurosurgeon performs the hospital admission, each physician should report his respective service.

For the neurosurgeon, you would submit initial hospital care with 99221-99223. The ED physician would bill the ED visit.