Pediatric Coding Alert

Question: If I see an ill child in the hospital in the morning and my partner sees the same child during the afternoon rounds, how should each of us bill for our visits?

Louisiana Subscriber

Answer: CPT permits reporting one hospital code per day per patient from the same provider. In your case, two pediatricians treated the child on the same day. Because they are in the same practice, they are the same physician from a coding perspective. Therefore, you should code only one E/M service. If the morning pediatrician admitted the patient to the hospital that day, you should assign 99221-99223 (Initial hospital care, per day, for the evaluation and management of a patient ). But if the doctor previously admitted the child to the hospital, you should report 99231-99233 (Subsequent hospital care, per day, for the evaluation and management of a patient ).

Although multiple same-day hospital codes are disallowed in this case, you may be able to combine both visits to support a higher-level E/M code. If documentation reflects increased history, examination and/or medical decision-making and/or time spent in counseling and/or coordination of care, you may add the work involved in the second visit to the first. In very complicated time-intensive scenarios, you may also report the prolonged services codes (+99356, Prolonged physician service in the inpatient setting, requiring direct [face-to-face] patient contact ; first hour; and +99357 ... each additional 30 minutes [list separately in addition to code for prolonged physician service]).

For instance, the morning pediatrician treats a 4-year-old female who was admitted the previous day for acute gastroenteritis and dehydration. She required intravenous (IV) hydration and is now stable. The doctor documents a problem-focused examination and straightforward medical decision-making and reports 99231.

During the second physician's afternoon rounds, the child's vomiting has returned and her temperature is elevated, so the physician further examines the patient and orders additional IV infusion. Based on the time and level of work involved in the second visit, the physician reports 99232. With proper documentation, you may roll both visits into a level-three subsequent hospital care code (99233).