Gastroenterology Coding Alert

Question: Can you use inpatient initial care codes 99221-99223 more than once in the same day if a different physician sees the patient?

South Carolina Subscriber

Answer: You can report a code from the 99221-99223 range (Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components …) range only once per day for physicians of the same group/specialty. You could, however, add up all the documentation for the day to determine the level of service which would fit best based on collective documentation by the physicians of the same group/ specialty seeing the patient. You use these codes to report the first hospital inpatient encounter with a Medicare patient.

The admitting physician adds the AI modifier (Principal Physician of Record) to indicate the service they are providing as the physician overseeing the patient’s care is distinct from other providers who may furnish specialty care. If physicians of different groups/specialties are consulted, they would also report codes from the 99221-99223 range as Medicare no longer recognizes consultation codes. These services would be reported without the AI modifier. As with the other E/M codes, you will decide the appropriate level of the initial hospital care code based upon history, examination, and medical decision making.

For other payers not following Medicare’s guidelines, i.e. payers who recognize inpatient consultation codes, only the admitting physician would use this code set. Other physicians who have initial inpatient encounters can look to initial inpatient consultation codes 99251-99255 (Inpatient consultation for a new or established patient, which requires these 3 key components …) or subsequent hospital care codes 99231-99233 (Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components …).

Remember: You cannot report another E/M service along with codes 99221-99223, but if the physician sees the patient multiple times during the first day, all the documentation would be used toward the level of service you select. If the patient is admitted on a subsequent day, then both the services can be reported.