Inpatient Facility Coding & Compliance Alert

Question: The provider wants to bill for initial hospital care using 99221, as well as three subsequent hospital care visits with 99231. Please clarify whether we could only bill out for 1 subsequent care and do they all go on one bill or do we bill each code on a separate bill for each day? 

Minnesota Subscriber

Answer:  You can report the initial hospital care with the E/M code 99221(Initial hospital care, per day, for the evaluation and management of a patient…). Remember that the admitting physician is considered “the physician of record” and only the admitting physician may file a claim for the initial hospital visit using the AI modifier (Principal physician of record). This modifier can be applied for Medicare patients only.

You are able to bill subsequent visits 99231(Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components…) for each day separately that your provider sees your patient in the hospital after he reports the admission code You do not have to submit them on one bill—that is up to your preference. Make sure that your provider has appropriate documentation when billing subsequent visits and that the documentation for each day billed can stand alone. Notes that state, “Unchanged since yesterday” are not acceptable.