Neurology & Pain Management Coding Alert

Question: When our neurologist admits a patient to the hospital after-hours from the emergency department (ED), how should I code her services?


California Subscriber


Answer: If the neurologist performs the ED visit and admission on the same date, you should combine all E/M charges that the physician performs and documents in the admission code (99221-99223, Initial hospital care, per day, for the evaluation and management of a patient ...).
 
CPT considers all E/M services that a physician provides on the same date in another site of service part of the initial hospital care. So, when your neurologist performs same-day outpatient and inpatient services, you should include the outpatient work in the initial hospital care level.

Watch out: If the physician performs services on different service dates, you should bill each service. For example, a neurologist treats an ED patient at 11:45 p.m. and admits the patient the next morning. Because the services occur on different dates, you should bill the ED service and the admission. Report the ED visit with 99281-99285 (Emergency department visit for the evaluation and management of a patient ...) and the admit as 99221-99223.

Be careful: Don't bill an ED visit and admission unless the neurologist performs both services. If the ED physician treats the patient but the neurologist performs the hospital admission, each physician should report his respective service.

For the neurologist, you would submit initial hospital care with 99221-99223. The ED physician would bill the ED visit.