Pediatric Coding Alert

Question: My colleague said that if a child is admitted to the hospital on the same day as the patient is seen in our office, we cannot bill for the office visit. I’m not sure about this since our doctors will not see the child in the hospital setting—a doctor from another practice or who is on the hospital staff will treat the patient during the hospital visit. In the office last week, we gave a child dual aerosol treatments and checked pulse oximetry three times. After reading the notes, code 99214 would be most appropriate, but if we can’t report anything, we believe we’re losing money and wasting time without compensation. What should we do?

Codify Subscriber

Answer: Your colleague seems to have a bit of confusion over the rules, which say that if Dr. Smith sees a patient in the office and the child subsequently goes to the hospital, where he is treated by Dr. Smith again, then you may not bill both a hospital admit and an office visit. However, if Dr. Smith sees the patient in your office and a different practitioner from another group treats the patient in the hospital, you’ll bill your 99214 and the other physician will bill the appropriate hospital visit code.

In circumstances when your physician treats a patient in the office and in the hospital on the same date, then you’ll only report one code by rolling both services into the hospital E/M code. For instance, a mother brings in her 18-month-old daughter, who has a high fever. Upon evaluation, the physician finds that the child is dehydrated. He sends the mother and child to the hospital with admission and intravenous infusion orders and evaluates the patient that evening in the hospital.

In this example, you should combine the office visit and initial inpatient hospital care into one hospital E/M code (99221-99223). Because the initial hospital care’s date coincides with the admission date, you should consider all related E/M services that the physician provides on that day part of the initial hospital care and submit only the inpatient code.

Here is another way to look at it: Let’s say Dr. Smith sees the patient in the late afternoon and admits the patient to the hospital but no one from the group sees the patient that evening. The next morning, one of Dr. Smith’s associates sees the patient in the hospital. The admission takes place on the date that the physician actually saw the patient in the hospital, so bill the office visit the day before and the admission the next day.