Urology Coding Alert

Question: Can you tell me how you would code if the patient comes to the office for an E/M and the physician decides to admit the patient, sending him directly to the hospital, and then doesn't see the patient until the next day in the hospital?

Oklahoma Subscriber

Answer: If a patient is admitted to the hospital by the urologist from his office but the physician doesn't see the patient in the hospital that day (examining the patient instead the following day), you should report the office visit on the date the urologist saw the patient in the office and then bill an initial in-hospital admission code (99221-99223) the next day.

The date of admission to the hospital and the first hospital visit by the urologist will not correspond, but this is the proper coding for your scenario. The first day the urologist sees the patient in the hospital becomes the initial hospital admission, not the actual day of admission.

When your physician examines a patient in the office and then admits him to the hospital and visits him at the hospital on that same day, proper coding limits you to billing only an initial in-hospital admission code (99221-99223) with no billing or payment for the office examination. You will not be paid for both an office visit and a hospital admission on the same day. However, there is an exception to this ruling, and that is the scenario you're describing.

Coding specifics: You should report an office visit based on whether the patient is a new patient or established patient. For the visit on the second day, choose the appropriate code from 99231-99233 (Subsequent hospital care, per day, for the evaluation and management of a patient ...) based on the level of service the urologist provided.

Tip: When you use an inpatient care code, you must report the corresponding place of service (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. As stated, you cannot bill or be paid for both a hospital admission and an office visit on the same day because the initial hospital inpatient care codes (99221-99223) include all the physician's services on that date whether performed in the office, emergency department, or in-hospital.

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