Primary Care Coding Alert

Question: Our family physician (FP) decides to admit an established patient to the hospital after going to the hospital on an emergency department (ED) physician's request. Although the FP fills out the admission orders from the ED, he does not go to the floor to see the patient on that date. Should I report the FP's services as an initial inpatient visit or an ED consultation?

Arizona Subscriber

Answer: Because the FP takes over patient management, you should report initial hospital care (99221-99223, Initial hospital care for the evaluation and management of a patient ...) for the visit. To report a consultation (99241-99245, Office consultation for a new or established patient ...), the FP would have to offer his opinion, rather than assuming patient care.

Suppose a pregnant women presents to the ED after a sexual assault. The ED physician requests the FP's opinion on the patient's prior mental status and ability to cope with the attack. After declaring the patient nonsuicidal, the ED continues with the evaluation and admits the patient to the hospital. Because the FP does not assume patient management, you should report a consultation (99241-99245) for her services.