Primary Care Coding Alert

Answer: Your understanding of how to code this case is correct, says Cynthia DeVries, RN, BSN, CPC, a coding and reimbursement coordinator for Lee Physicians Group, a 140-provider, multispecialty practice in Ft. Myers, Fla. In essence, billing for both the office visit, 99058 (office services provided on an emergency basis) and the hospital admission (one of the codes in E/M series 99221-99223 [initial hospital care]) on the same date would be charging for the same service twice evaluating symptoms and diagnosing the heart attack. Billing both services, with or without a modifier, would not be appropriate.

The best way to report your physicians services and to receive reimbursement appropriate to the work done is to bill for the EKG, 93000 (electrocardiogram, routine ECG with at least 12 leads; with interpretation and report) and blood draw (i.e. 36415, routine venipuncture or finger/heel/ear stick for collection of specimen[s]) that was done in the office.

In addition, you will want to make sure that the code assigned for the hospital admission also reflects the level of care provided in the office setting. All three levels of the hospital admission code describe the key components to be considered when assigning the correct code including the complexity of the medical decision-making.