Otolaryngology Coding Alert

Question: Can we charge an office visit and admit on the same day if the otolaryngologist sees the patient in the hospital on the same day, or should we only charge an admit after an office visit if the physician doesn't see the patient again until the next day in the hospital?


Louisiana Subscriber

Answer: If an otolaryngologist sees a patient in the hospital after treating him in the office on the same day, you should assign only one E/M code: the hospital admit code (99221-CPT 99223 , Initial hospital care, per day, for the evaluation and management of a patient ...). When selecting the level of initial hospital care, also include the history, examination and medical decision-making involved in the same-day office visit E/M service. Be sure the inpatient record includes any office visit documentation the otolaryngologist may reference in his admission note.

CPT considers office visit and hospital care -per day- codes, meaning you should use only one of these codes for a given date of service. Based on this guideline, most insurers will deny a same-day office visit when billed in addition to a hospital care code. Don't assume that 99221-99223 are admission codes that have to coordinate with hospital admission dates. These codes are for initial hospital care, which you should bill when the initial face-to-face occurs.

As you indicated, if the otolaryngologist did not perform a face-to-face inpatient service on the same day as the office visit, you would separately bill each E/M service. Here's how:

Day 1: When the otolaryngologist admitted the patient to the hospital from the office but did not see the patient in the hospital, assign the appropriate-level office visit service (99201-99215, Office or other outpatient visit).

Day 2: If the patient is admitted to the ENT's service, and the first face-to-face inpatient-otolaryngologist encounter occurs within the first 24 hours of admission, report initial hospital care (99221-99223).