Practice Management Alert

Question: A hospitalist dictates an initial hospital visit (admit) and a discharge within the same note. She dictates "anticipated stay 2-3 days, if XYZ then discharge ..." The patient was admitted Day 1 then discharged Day 2. The hospitalist only saw the patient on Day 1. Can we bill the admission on Day 1 and the discharge on Day 2? If we cannot, do we only charge the admission? I am unsure because there was no face-to-face on the day of discharge and I cannot use the same day admit/discharge because the patient stayed two days.

Answer: You should only bill the admission. Since your hospitalist did not perform a face-to-face service for the discharge, and there was no discharge planning and no instruction to the patient, you cannot also bill the discharge. The discharge hypothesis that the hospitalist dictated inthe admission note becomes part of the medical decision making (MDM) for the admit.

Remember: CPT does not include a code for hospital admission itself.

The admitting physician should bill codes 99221-99223 (Initial hospital care, per day, for the evaluation and management of a patient ...) for her care if she documents the elements contained within the codes (appropriate history, exam, and medical decision-making). She is not billing for the admit itself -- she's billing for the care that she provides, based on the documentation.