Pediatric Coding Alert

Question: My pediatrician saw a patient on Thursday night while he was the attending physician. He then saw the patient again on Friday for a follow-up in the afternoon. The date of admission according to the hospital is Friday, so how should I bill for the initial day and the follow-up?

Colorado Subscriber

Answer: Reporting the first encounter depends on how the patient was registered on the initial day. If the patient was registered as an emergency department (ED) patient during the time that your pediatrician saw her, you have the option to report an ED visit (99281-99285, Emergency department visit for the evaluation and management of a patient), an outpatient consultation (99241-99245, Office consultation for a new or established patient), or a new/established patient office visit code (99201-99215, Office visit for a new or established patient).
 
Note: If your pediatrician admits the patient to the hospital on the same calendar date as the ED or office visit, you may only report the hospital admission service (99221-99223, Initial hospital care) if the patient is seen face to face in that setting by the admitting physician.
  
Beware: You can only report observation codes (99218-99220, Initial observation care, per day, for the evaluation and management of a patient) if the patient is formally admitted to observation and assigned an "observation" status by the hospital and you see the patient in the observation setting.
 
Since the patient was not admitted to the hospital on the previous calendar day, report the initial admission service for your physician's service on Friday.