Primary Care Coding Alert

Get the pay you deserve for 2-day services
 
How can you earn your fair share of reimbursement for office visits that result in hospital admissions? Separately report 99201-99215 when your family physician (FP) waits to see the inpatient the next day.

FPs in group practices that rotate hospital rounds can further complicate coding for the two E/M services, says Suzanne Rushton, insurance office manager at Piedmont Health Group, a twelve-FP practice with four locations in Greenwood, S.C.

For instance, an FP may see a patient in the office and admit the patient to the hospital on day one (99201-99215, Office visit for the evaluation and management of a new or established patient ...) while another FP visits the patient in the hospital and performs initial hospital care the following morning (99221-99223, Initial hospital care, per day, for the evaluation and management of a patient ...), Rushton says.

To simplify the coding options and improve your E/M reimbursement, coding experts recommend that you bill based on four scenarios: 1. Office Visit Results in Hospital Admit Suppose a 50-year-old male with chest pains presents to his FP's office. After performing a history, evaluation and medical decision-making, the FP admits the patient to the hospital as an inpatient but does not see the patient in the hospital that day.

In this case, you should report the appropriate-level office visit code (99201-99215), says Kent J. Moore, the American Academy of Family Physician's (AAFP) healthcare financing and delivery systems manager. Because the FP doesn't see the patient in the hospital on the admission date, you should use the E/M code that reflects where the physician delivered the services, he says. Since the FP performs an office visit only, you should only report that day's service. 2. FP Performs Same-Day Related E/Ms
 
But when the office visit and initial hospital care occur on the same day, you should roll both services into one E/M code. For instance, a mother brings in her 18-month-old daughter who has a high fever. Upon evaluation, the FP finds that the child has 10 percent dehydration. So, the FP sends the mother and child to the hospital with admission and intravenous infusion orders. That evening, the FP visits the patient in the hospital and checks on her progress.

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 FP provides on that day part of the initial hospital care and submit only the initial hospital care codes, Moore says.

Moore bases his advice on CPT's passage stating that  when a physician admits a patient to inpatient [...]