Cardiology Coding Alert

Question: One of our patients had an office consultation (99215, Office or other outpatient visit for the evaluation and management of an established patient & ). Three days later, the patient had an angiogram and stent. Following that, the patient was admitted to the hospital on the same day. Can we bill 99222 (Initial hospital care, per day, for the evaluation and management of a patient, which requires these three components: a comprehensive history; a comprehensive examination; and medical decision making of moderate complexity)?

Michigan Subscriber

Answer: Because the procedure was scheduled and any service rendered as part of the procedure is included, you cannot bill for the admission unless the cardiologist hospitalizes the patient for some other reason. In other words, if admission for this procedure is routine, you will not be able to bill for that.

You can bill an E/M service, however, if the condition is separate and not an expected part of the scheduled procedure. For instance, if after the angiogram and stent the patient leaves the hospital and falls and breaks a hip on the same day and returns to the hospital, you can admit the patient with an E/M for the hip fracture.