Wiki 23 hr observ and changed to Inpt

[heartyoga]

Pt was initially admitted as 23 hr observ on Day 1 so we coded 99215 (pt is established in our clinic), however, on Day 3 pt was admitted as an inpt.

Do we go back and code Day 1 as inpt 99221-99223 consult code or start as a follow up code 99233-99231 on Day 3?

Pt is Medicare pt.

Thanks.

 

[SharonCollachi]

Why didn't you choose a code from the observation section of the CPT book? New or established is not a factor in hospital care.

 

[prashanjitb]

When the Pt was admitted as observation status, report E/M observation care codes.

Day 2 scenario?

on Day 3 pt was admitted as an inpt status, report E/M initial hospital care.

When the Pt is admitted as an inpt in the course of an encounter in another site of service ( eg:-ED, Office ..... etc) all E/M services provided by that physician in conjunction with that admission are considered part of the initial hospital care when performed on the same date as the admission.

Hope this will help you.

 

[thomas7331]

Pt was initially admitted as 23 hr observ on Day 1 so we coded 99215 (pt is established in our clinic), however, on Day 3 pt was admitted as an inpt.

Do we go back and code Day 1 as inpt 99221-99223 consult code or start as a follow up code 99233-99231 on Day 3?

Pt is Medicare pt.

Thanks.

The established patient code is correct for a Medicare patient if your physician was consulting during the observation period - only the attending physician would use the observation care codes. The inpatient period does not begin until the order to admit is actual written, so you would use an initial or subsequent inpatient code, depending on documentation, beginning on the actual day of admission.

Guidelines from Medicare for coding of consultations in the hospital can be found here:

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM6740.pdf