Internal Medicine Coding Alert

Published on Tue Jun 06, 2006 PDF

What Day Qualifies for 99221-99233?

Question: After an internist examines a patient in his office in the afternoon, he decides to send the patient to the hospital to be admitted. The internist, however, does not see the patient in the hospital until the next morning. Which day should I report as initial hospital care?


Michigan Subscriber


Answer: You should code the first time the internist sees the patient in the hospital with 99221-99223 (Initial hospital care, per day, for the evaluation and management of a patient ...). Initial hospital care codes represent initial face-to-face services after hospital admission.

Because the internist does not see the patient in the hospital on day one in your case, you should assign 99221-99223 on day two. For the first day's services when the internist treats the patient in the office, report the appropriate-level office or other outpatient service code (99201-99215).

Important: If the internist had seen the patient in the hospital on the same day that he treated him in the office, you should report only 99221-99223 on day one.
 
"When the patient is admitted to the hospital as an inpatient in the course of an encounter in another site of service (e.g., ... physician's office ...) all evaluation and management services provided by that physician in conjunction with the admission are considered part of the initial hospital care when performed on the same date as the admission," according to CPT's introductory notes for initial hospital care.

When selecting the inpatient care level of service, remind the internist to include the office services that he performed and documented. You would then use a subsequent hospital care code (99231-99233) for the service he provides the next day.