Internal Medicine Coding Alert

Question: Our physician was called at home by the hospital late at night to OK an admit and give orders for the patient's care. The physician saw the patient the next morning and took a history, performed a physical, etc.

Can the physician charge the admit (99221-99223) even though she didn't see the patient on the admission night? If so, which date is used? If we charge the admit for the next morning, won't that cause a problem because the hospital will submit an initial hospital day for the previous evening?

Montana Subscriber

Answer: Yes, the physician can charge for the admission, and it should be charged on the day that the physician actually sees the patient.

Read CPT's description of the 99221-99223 series (Initial hospital care) and you will see that these codes require the physician to complete a history and an examination. Therefore, you cannot code the admission until the physician has a face-to-face encounter with the patient.

E/M guidelines permit a physician to "spend time doing work before or after the face-to-face time with the patient, performing such tasks as reviewing records and tests, arranging for further services, and communicating with other professionals and the patient through written reports and telephone contact," notes the January 2002 issue of CPT Assistant. Use of the 99221-99223 series a day after the patient is admitted may seem confusing for payers, but this scenario is common and should not cause a problem with your payer.