Orthopedic Coding Alert

Question: A patient presented to our office after a heavy piece of furniture fell on him at work. Dr. Jones admitted the patient to the hospital as an inpatient. He wrote all of the admission orders, signed them and sent copies to the hospital. Dr. Jones did not visit the hospital that day. On hospital rounds the next morning, Dr. Smith, who is also an orthopedist in our practice, saw the patient. How should we code for the admission, and which physician should report it?

Tennessee Subscriber

Answer: The AMA book "Principles of CPT Coding" states that the initial hospital care code is for the "first inpatient encounter with the patient by the admitting physician. The date may not be the same as the date the patient was actually admitted to the hospital." Assuming, therefore, that both physicians are billing under the same provider number and thus are interchangeable from the insurer's perspective, you should code the hospital service on the second day as initial hospital care (99221-99223, Initial hospital care, per day, for the evaluation and management of a patient ...) under Dr. Smith's name.