Pediatric Coding Alert

Question: A pediatrician sees an established patient in the office for high fever and dehydration. The physician decides to immediately admit the patient to the hospital, where a hospitalist takes over the child's care. How should I code for the pediatrician's services?

Florida Subscriber

Answer: You should code only for the office visit (99212-99215, Office or other outpatient visit for the E/M of an established patient ...) with the conditions the physician treated, such as fever of unknown origin (780.6). The hospitalist will code for the admission and any diagnostic work.

If your pediatrician provided care for the patient in the hospital, you would instead use an admission code (99221-99223, Initial hospital care, per day, for the E/M of a patient ...) and combine all the outpatient and inpatient E/M services that day, if the physician or another physician of the same group saw the patient face-to-face in the hospital on the admission day.

If the pediatrician did not see the patient until rounds the following morning, you would instead code the office visit on day one (9921x) and the initial inpatient care on day two (9922x) when the first face-to-face pediatrician-inpatient encounter occurred.