Expert Answers to Your Top-5 Inpatient E/M Coding Questions
Published on Thu Apr 19, 2007
Guest Columnist: Catherine Brink, CMN, CPC
You can set yourself up for clean claims and stop expensive mistakes. The key Know how to accurately assign the right E/M code for your urologist's hospital care.
If you ever find inpatient E/M coding tricky, the answers to the following five questions may help you submit your claims with fewer headaches and better reimbursement odds. Limit E/M Charges to Once per Day Question 1: If the orthopedic surgeon provides an office-based E/M visit and then later in the day admits the patient to the hospital, how can we get reimbursed for all of our work? Do we have to write off the other E/M services that weren't related to the inpatient admission? Answer 1: You don't have to write off the outpatient E/M visit, but you are correct that you can only charge one E/M visit every 24 hours. Therefore, the work that the surgeon performed during the office E/M visit that occurred earlier in the day should be considered when selecting a code for the hospital admission (99221-99223), assuming that the surgeon has a face-to-face encounter with the patient during the admission that day.
The combined E/M components of the office visit and the hospital admission are the keys that help the physician and the coder select an accurate initial inpatient service code.
Caveat: Keep in mind that the rules change if the orthopedic surgeon performed an E/M service in the office on Monday and admitted the patient on Monday, but did not have an actual face to face inpatient E/M service until Tuesday. If that occurred, you would charge for the E/M office service on Monday and the hospital inpatient admission on Tuesday, since these services did not occur on the same date. Determine Inpatient or Outpatient Status in the Hospital Question 2: A pulmonologist admits a patient to the hospital. The patient suffered a punctured lung during a motorcycle accident, but the patient also has severe pain in his legs and his left shoulder. The pulmonologist requests a consultation from an orthopedic surgeon prior to the admission. Should the surgeon report a consult, an initial inpatient visit, or a subsequent care hospital visit?
Answer 2: If the pulmonologist requests a consultation from the orthopedic surgeon asking about the severe pain in the legs and left shoulder, then the E/M service should be documented and charged as a consultation, assuming the surgeon correctly documents the required components of the consult codes.
The question is: Should you charge an inpatient consultation (99251-99255) or outpatient consult (99241-99245)? To determine the answer, first find out the status of the patient when the orthopedist rendered the consultation.
The solution: If the patient was admitted to observation status? the consultation would be [...]
