Primary Care Coding Alert

Question: When our family physician (FP) admits a patient to the hospital after hours from the emergency department (ED), how should I code her services?

California Subscriber

Answer: If the FP performs the ED visit and admission on the same date, you should combine all services that the physician performs and documents in the admission code (99221-99223, Initial hospital care, per day, for the evaluation and management of a patient ...).

CPT considers all E/M services that a physician provides on the same date in another site of service part of the initial hospital care. So, when your FP performs same-day outpatient and inpatient services, you should include the ED work in the initial hospital care level.

Watch out: If the physician performs services on different service dates, you should bill each service. For example, an FP treats an ED patient at 11:45 p.m. and admits the patient after midnight. Because the services occur on different dates, you should bill the ED service and the admission. Report the ED visit with 99281-99285 (Emergency department visit for the evaluation and management of a patient ...) and the admit as 99221-99223.

Be careful: Don't bill an ED visit and admission unless the FP performs both services. If the ED physician treats the patient but the FP performs the hospital admission, each physician should report his respective service.

For the FP, you would submit initial hospital care with 99221-99223. The ED physician would bill the ED visit.