Wiki 99221 or 99233??

[bridgekup]

I work for a private neurosurgery practice that sees patients at all local hospitals. In the past, when a patient was seen at the hospital, we weren't able to code new patient visits as 99221 because the patients had already been seen by another hospital provider on the same day so we would code 99233 (or whichever subsequent code is appropriate!). With the new guidelines, I am understanding it to say that we can now use 99221 since it is a new patient for our MD and they haven't been seen by another provider in the same specialty or from the same practice. Is that correct? Or are they considered same practice since admitting MD and our MD are both hospital providers? Thanks!

 

[thomas7331]

CPT code 99221 is not a new patient visit - it's an initial visit, to be used for the first time a provider evaluates a patient in a given inpatient hospital stay. It does not matter if the patient is new or established to that provider if it's the first time the provider is seeing the patient since being admitted. I've heard there are some payers that will only allow one provider to bill 99221 (or 99222 or 99223, depending on documentation), but in most cases the attending provider will bill those codes with the AI modifier, and any specialists would also see the patient may also bill those codes without the modifier - each different specialty can have an initial visit for that specialty. I'm not sure why you were told that your provider couldn't use those codes if another hospital provider had seen the patient, but that's generally incorrect unless your provider is of the same specialty and is covering for the hospital provider on a given day.