Primary Care Coding Alert

Question: A family physician treats in our office a patient who has difficulty breathing. Because the patient's condition doesn't improve, the physician admits him to the hospital and visits him later that day. The insurer won't pay for two visits on the same day. How should I report the services?

New Jersey Subscriber

Answer: You should roll the E/M visits into one code. Include the office visit's work in the initial hospital care code that you select (99221-99223, Initial hospital care, per day, for the evaluation and management of a patient ...).

For instance, your FP performs and documents a level-four office visit, which includes a detailed history, detailed examination, and moderate-complexity medical decision-making. When he treats the patient at the hospital, he performs a comprehensive history, comprehensive examination, and moderate-complexity decision-making.

Individually, his documentation equals 99214 (Office or other outpatient visit for the evaluation and management of an established patient ...) and 99222. But you should combine the earlier office visit with the initial hospital care and submit an initial hospital care code that reflects the sum of the work of both services, which may result in reporting99223.