Pulmonology Coding Alert

South Carolina Subscriber

Answer: Per CPT guidelines, you would use only one subsequent care code (99231-99233, Subsequent hospital care, per day, for the evaluation and management of a patient ...). Yes, these are "per day" codes, which include all the day's services. The physician would choose the appropriate level of subsequent care that reflects all the E/M services documented by members of the same specialty group practice for that patient on the date of service.

Medicare explains this concept in Transmittal 1545,effective April 1, 2008: "Both initial inpatient hospital care codes and subsequent hospital care codes are 'per diem' services and may be reported only once per day by the same physician or physicians of the same specialty from the same group practice."

Although Medicare and CPT guidelines can vary, they are the same for two hospital visits on the same day. Before coding 9923x and 9923x-25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) for the same day, first obtain written documentation from the insurer confirming its reimbursement policy for multiple hospital visits on the same day.