Practice Management Alert

Question: A 57-year-old patient reported to our hospital's emergency department (ED) early in the morning for evaluation of uncontrollable shaking in his extremities and severe pain in his neck. The emergency practitioner (EP) admitted the patient and ordered blood tests and a CT scan, but the shaking got worse. The EP consulted with a neurologist, who recommended the patient be hospitalized. The neurologist admitted the patient to the hospital as an inpatient that evening for more examination. The notes indicate a comprehensive history and exam was performed, along with moderate medical decision making. As the ED physician's biller, should I bill this as an inpatient service?

Nebraska Subscriber

Answer: No, you should not use an inpatient code,such as 99222 (Initial hospital care, per day, for the evaluation and management of a patient ...). Although they can recommend hospitalization, ED physicians do not admit patients to hospital inpatient status.

In this situation, you will bill a 99281-9928x code (New or established patient emergency department services ...) for the ED physician. Append 781.0 (Abnormal involuntary movements) and 723.1 (Cervicalgia) to represent the patient's symptoms.

For his services, the neurologist will code 99222.