Wiki Inpatient New Visit E/M

[banjocat]

Medicare patient is admitted to hospital on 11/3. A cardiologist sees the patient on 11/7. Is this billed with an initial hospital visit (99221-99223), a subsequent hospital visit (99231-99233) or a consultation code (99251-99255)?

 

[beck123]

Medicare doesn't pay in pt or office consults. If this is the first time the cardiologist is seeing the patient, they should bill initial hospital visit.

 

[cshrum]

initial hospital visit.

Make sure when you use an initial visit code for the first day in the hospital and your physician is the admitting physician, you use an AI modifier on on the 99221-99223. Then, when another physician comes in behind and uses another initial visit code, even if it is the same day, they do NOT use the AI modifier. and that lets the insurance company know which physican is actually admitting the patient.

 

[MnTwins29]

If the visit doesn't meet the criteria for the initial inpatient visit codes - remember, the History and Exam have to be at least Detailed - then the appropriate subsequent hospital visit code can be used by the consulting physician. This would not be the case for the admitting physician.