Primary Care Coding Alert

Question: Dr. A admits a patient to the hospital and bills this as a level-one hospital admission. Dr. B follows up with the patient later the same day because the patient needs labs and an x-ray reviewed. How do both doctors get paid for their time?

Louisiana Subscriber

Answer: If Dr. A and Dr. B are part of the same group and billing under the same group number, the combination of their services is no different than if Dr. A provided both services. Most payers treat physicians billing under a single group number as a single entity.

However, if the two physicians are separate entities, Dr. A will get reimbursed for 99221 (Initial hospital care, per day, for the E/M of a patient ...). Dr. B should bill the appropriate initial inpatient consultation code (99251-99255) if he or she performed the follow-up visit at the request of Dr. A. In this case, Dr. B needs to send a written report to Dr. A detailing why he was asked to see the patient, his opinion on the patient, and any recommended treatment. If, however, Dr. A. did not request that Dr. B see the patient, Dr. B can bill the follow-up visit with the appropriate-level subsequent hospital care code (99231-99233). Both doctors can use the same diagnosis code.