Wiki E/M coding question-Our Doc saw

[jennifer daniels]

Our Doc saw a patient 11am in his office for HTN among other dx and then that evening she was admitted to the hospital for HTN. Our provider rendered services to her at the office and facility same day with same dx. Can we bill for both services considering #1 she was stable/well after leaving the office and the condition worsened later and #2 he assessed additional dx during the office visit? Please advise where I can find the answer to this scenario and which service would I append a modifier to?

 

[mcpalmeter]

E/M coding question

Hi Jennifer,

Please read the guidelines in the E/M section of CPT under the Initial Hospital Care subsection.

When a patient is admitted to the hospital as an inpatient in the course of an encounter in another site of service...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. The inpatient care level of service reported by the admitting physician should include the services related to the admission he/she provided in the other sites of service as well as in the inpatient setting.

Bill the initial hospital care code but include all related work done in the office.

Maryann

 

[jennifer daniels]

Maryann,
Thank you for your reply. We did read and understand those guidelines. We have had patients who come into the office with a particular condition and end up being seen at a facility same day for the same dx and we do not bill the office visit. I just wanted to make sure and clarify because of the assessment he provided on dx other than the admitting (HTN) dx that were included in the office documentation. So, he cannot be separately reimbursed for the office visit, although there were other conditions evaluated during that encounter? I'm sorry to ask for confirmation again. I sincerely appreciate your response and help.
Jennifer

 

[NeoCoder116]

Jennifer,

Maryann's assessment and recommendation for your case are accurate. I used to code for a physician group in a Hematology/Oncology practice so we had a lot of patients who would fall in the same category you described. We would NOT bill the office visit (99211-99215) because the initial care code for the hospital admission (99221-99223) would reimburse the physician for their work that day with the patient. I think it is an advantage for the coder because you can generally use both notes and combine it to work the admission code to a level 2 or 3, assuming medical necessity supports the higher level.

Only bill the inpatient code, 99221-99223.

I hope this helps clarify it for you as I once too needed that clarification.

Erwin