Practice Management Alert

The popular misconception among physicians and coders has been that initial hospital care codes (99221-99223) are for patient admission, says Suzan Hvizdash, BSJ, CPC, physician education specialist in the department of surgery at the University of Pittsburgh Medical Center in Pittsburgh.

But you can only bill for initial hospital care if the admitting physician sees the patient in the hospital on the same day, Hvizdash says. Follow these two guidelines to report initial hospital care correctly every time:

1. Check the dates of admission and discharge. First you must make sure the patient wasn't admitted and discharged on the same date of service, says Marvel Hammer, RN, CPC, CHCO, president of MJH Consulting in Denver. For same-day admission and discharge, you will report observation or inpatient care services codes (99234-99236).

2. Determine same or different dates of service. If a physician admits a patient and renders initial inpatient treatment all on the same calendar day, you should bill an initial hospital care code to recoup for all of the physician's services that day.

Beware office admits: Suppose your physician examines a patient in his office late in the afternoon on Monday and sends the patient to the hospital to be admitted. If the physician doesn't actually have a face-to-face encounter with the patient in the hospital until Tuesday morning, you should bill two separate codes for the two separate dates of service, Hammer says. You would bill an outpatient E/M code to account for the services on Monday. Then you would report an initial hospital care code to account for the initial treatment on Tuesday morning.