Otolaryngology Coding Alert

Question: Our otolaryngologist saw a patient on September 6 in the hospital, and we billed 99222. The patient was discharged from that hospital and readmitted to a different hospital for the same diagnosis later that evening. Our physician saw the patient at the new hospital on September 7. Should we report 99222 for both dates of service since the visits occurred at different hospitals?

Texas Subscriber

Answer: When you’re reporting 99222 (Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components: a comprehensive history, a comprehensive examination, and medical decision making of moderate complexity), you’re telling the insurer that you performed a complete workup required of a newly-admitted patient.

However, if the physician saw the patient for the same reason the previous day, they probably didn’t require a complete admission workup. Despite seeing the patient at a new location, the reality is that the physician likely performed a subsequent hospital visit instead (99231-99233) on the second day of service. Therefore, you’d report 99222 for September 6 and a code from the 99231-99233 range for September 7.