Pediatric Coding Alert

Question: Can you use inpatient initial care codes 99221-99223 more than once in the same day if a different physician in the same practice sees the patient?

West Virginia Subscriber

Answer: No. You can report a code from the 99221-99223 range (Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components …) range only once per day. You could, however, add up all of the documentation for that day to determine the level of service that would fit best based on that collective documentation by the physician. You use these codes to report the first hospital inpatient encounter with a patient. As with the other E/M codes, you will decide the appropriate level of the initial hospital care code based upon history, examination, and medical decision making.

Some payers will only allow the admitting physician to report initial inpatient care with 99221-99223. There are coding options for other physicians who have initial inpatient encounters, but aren’t the admitting physician. If a physician has an initial encounter with a patient, but she is not the admitting physician, some payers might prefer you to use an initial inpatient consultation code 99251-99255 (Inpatient consultationfor a new or established patient, which requires these 3 key components …) or subsequent hospital care code 99231-99233 (Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components …) for the service.

Best bet: Check with your payer if you have any questions about filing initial inpatient services performed by the admitting physician, or about choosing a code for initial inpatient services for a non-admitting physician.