Eli's Rehab Report

Question: I was recently called into the hospital to take over the care of a stroke patient who was unable to get along with her previous physiatrist (personality conflicts). I began my care of the patient three days into her eight-day hospital stay. How do I code for my first inpatient visit with this patient? Is this initial hospital care or subsequent hospital care?

Illinois Subscriber

Answer: CPT 2000 states that the initial hospital care codes are used to report the first hospital inpatient encounter with the patient by the admitting physician. For initial inpatient encounters by physicians other than the admitting physician, see initial inpatient consultation codes (99251-99255) or subsequent hospital care codes (CPT 99231 -CPT 99233 ) as appropriate.

In your case, it sounds as if you were not performing a consultation, so you would use one of the subsequent hospital care codes. These codes represent both new and established inpatient visits, so even if you have never met the patient before, you would still bill the 99231-99233 series. If you took over the patients care during a global postsurgical period, you could bill for postoperative care only by modifying your inpatient visit code with modifier -55 (postoperative management only).

Editors note: Brenda Messick, CPC, senior consultant at Gates, Moore & Co., a physician practice management firm in Atlanta, answered the You Be the Coder question.