Pulmonology Coding Alert

Question: A patient presented to our office with shortness of breath. Our physician subsequently rushed the patient to the hospital and admitted him for treatment of dehydration and asthma. Which place of service (POS) is appropriate for this service?

West Virginia Subscriber

Answer: The answer depends on what you mean when you say the pulmonologist rushed the patient to the hospital.

If he saw the patient in the office and then had an ambulance take her to the hospital, then he probably only actually treated her in the office setting. In that case, report an office visit code with POS code 11 (Office).

If, however, you mean that your clinic is within the same complex as the hospital and the physician (or someone from the same specialty group practice) personally provided the admission service, you should instead report an inpatient care code. In that case, you must report the corresponding POS code 21 (Inpatient hospital). The POS code on your claim should always be consistent with the site of service indicated in the codes you report. And you can’t bill for both a hospital admission and an office visit on the same day because the initial inpatient care codes (99221-99223) that describe your physician’s work treating the patient in the hospital setting include all the physician’s services on that date.

Therefore you should combine all the physician’s work and documentation to determine the appropriate-level initial inpatient care code to cover the office visit, admission services and other inpatient treatment that day.