Oncology & Hematology Coding Alert

Question: Our oncologist saw a patient on 2/1/20 and then admitted her on 2/2/20. What code should I use for the 2/1/20 visit? The hospital has the admission date as 2/2/20.

Kansas Subscriber

Answer: The question doesn’t specify where the patient was seen on 2/1/2020. Therefore, here are a few options to consider.

Observation patient: If the patient was admitted to observation on 2/1/20, then admitted to inpatient level of care on 2/2/2020, you should bill one of the observation setting admission codes (99218-99220, Initial observation care, per day, for the evaluation and management of a patient …) for the initial observation care. 

If the patient was seen in the office on 2/1/2020 or in the hospital, but not in observation and they are established to the provider, a code from 99211-99215 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of … 3 key components…) would be most appropriate. If the patient was new to the provider / group practice, a new patient 99201-99205 (Office or other outpatient visit for the evaluation and management of a new patient, which requires … 3 key components…) would be chosen as supported by the documentation.

For non-Medicare patients and for those carriers who still recognize consultations, if the visit was a consultation and documentation supported this type of visit, a code in the range of 99241-99245 (Office consultation for a new or established patient, which requires these 3 key components…) would be chosen.

If in a setting other than seen in the office or in observation, you would look to the most appropriate E/M category and choose the level to code based on the requirements of the level compared to the supporting visit note.