Wiki Initial Observation E/M for Hospitalists and Primary Care Physicians

[Brenda Ray]

We heard that if the hospitalist would see the patient initially they could bill the initial E&M observation visit and if they would transfer service to the patient's family physician that they too could bill initial E&M observation if same calendar day but one of them would need to append a modifier for reduced service. Is this accurate? Which modifier would be appended if appropriate?

 

[shirleyharris]

Shirley CPC, CPMA

This was addressed in the November Hospitalist magazine. Provided the Hospitalist and the family Physician are not part of the same group, each Physician seeing the patient for the first time can use the codes 99218-99220, as these codes are for initial hospital care. I don't know about using a modifier for reduced service, but the AI modifier should be used, by whichever Physician is denoted as principal Physician of record, for Medicare and other carriers who have discontinued using consultation codes.

 

[Brenda Ray]

Shirley,

Thank you for your prompt response. Are you referring to APC's Hospitalist Magazine or Today's Hospitalist? I cannot locate any reference in either of these November issues for this topic.

Would you please provide the link to that article?

Thanks again!