Urology Coding Alert

Question: Dr. Smith was on-call and in the early morning admitted a patient to the hospital from the emergency department. The admission and orders were given over the phone. Later that same day, our urologist (Dr. Jones) took over as the on-call physician for that day. He saw the patient and discharged her that day. Because we admitted and discharged the patient on the same day, which physician should report 99235?

New Jersey Subscriber

Answer: Because Dr. Jones saw the patient and Dr. Smith did not, only Dr. Jones should bill 99235 (Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date ...).

You can report 99235 only if the physician actually sees and examines the patient. Because Dr. Smith admitted the patient over the phone and did not see the patient, he cannot report an E/M code.
 
Remember: Only use CPT codes 99234-99236 if the patient's hospital stay is at least eight hours or more. If the stay is less than eight hours, you should only report a hospital admission code, 99221-99223 (Initial hospital care, per day, for the evaluation and management of a patient...), with no added discharge code.