Wiki 99215 and 99223 same day?

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kebertha

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During a follow-up office visit, our provider advised the patient to go to the ER where he was subsequently admitted. Our provider then saw the patient again as inpatient on the same day. I doubt I can bill for both encounters, but I don't know which one I should go with, the office visit or the hospital visit.
Does anyone know what to do in this situation? I did a bit of research but still don't have a full understanding of the protocol with this. Thank you!
 
You are correct that you can typically only bill for one E/M encounter per day. In this instance, you would combine the documentation to get your level of service and I would bill the hospital visit.
 
Agree with Amanda, you can roll it up and combine. Question is - while your provider advised the patient to go to the ED, were they the admitting (AI mod)?
4. If we decide to admit from the office, should we bill the office visit and the lowest initial admission code?
No, if admitting the patient after an office visit, the initial hospital code would include all work performed by the physician in all sites. The initial hospital care day would be the only code reported if the physician performed a face-to-face visit in the hospital setting as well as the office.

30.6.9.1 - Payment for Initial Hospital Care Services and Observation or Inpatient Care Services (Including Admission and Discharge Services) (Rev. 2282, Issued: 08-26-11, Effective: 01-01-11, Implementation: 11-28-11)
A. Initial Hospital Care From Emergency Room A/B MACs (B) pay for an initial hospital care service if a physician sees a patient in the emergency room and decides to admit the person to the hospital. They do not pay for both E/M services. Also, they do not pay for an emergency department visit by the same physician on the same date of service. When the patient is admitted to the hospital via another site of service (e.g., hospital emergency department, physician’s office, nursing facility), all services provided by the physician in conjunction with that admission are considered part of the initial hospital care when performed on the same date as the admission.

0.6.11 - Emergency Department Visits (Codes 99281 - 99288) (Rev. 1875, Issued: 12-14-09, Effective: 01-01-10, Implementation: 01-04-10)
E. Physician Billing for Emergency Department Services Provided to Patient by Both Patient’s Personal Physician and Emergency Department Physician
• If the patient is admitted to the hospital by the patient’s personal physician, then the patient’s regular physician should bill only the appropriate level of the initial hospital care (codes 99221 - 99223) because all evaluation and management 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.
 
Hi there,
If this is for a private payer you'll need to check the reimbursement policy. Your 2023 CPT manual updated the E/M guidelines to allow both services on the same day.

"When the patient is admitted to the hospital as an inpatient or to observation status in the course of an encounter in another site of service (eg, hospital emergency department, office, nursing facility), the services in the initial site may be separately reported. Modifier 25 ...."
Click to expand...

Medicare did not adopt this policy.
 
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