Primary Care Coding Alert

Question: After taking care of a hospital patient for three days, a family physician (FP) transfers the patient to an inpatient rehabilitation ward. The patient remains in the rehab ward for two weeks. The FP then discharges the individual from the hospital. Which E/M codes should I submit for the rehab ward services?


Florida Subscriber


Answer: You should count the rehab ward services, including the transfer day, as hospital care. The rehabilitation ward is just another part of the hospital and not a separate facility, such as a nursing facility (99301-99316, Nursing facility services). Therefore, you should report subsequent hospital care (99231-99233, Subsequent hospital care, per day, for the evaluation and management of a patient ...) for all service days except the hospital admission and discharge days. The claims could include:
  Day 1: Admission - 99221-99223 (Initial hospital care, per day, for the evaluation and management of a patient ...)
  Days 2-3: Hospital inpatient - 99231-99233
  Day 4: Transfer to inpatient rehabilitation ward - 99231-99233
  Days 5-17: Rehab ward inpatient - 99231-99233
  Day 18: Hospital discharge - 99238-99239 (Hospital discharge day management ...).