Oncology & Hematology Coding Alert

Question: I have trouble determining how to code professional encounter services for a patient who was in observation, then admitted to the hospital, and then discharged. How would I report: observation August 20, admitted August 21, and discharged August 22? Also, should I list place of service as inpatient or observation?

Pennsylvania Subscriber

Answer: If the same practitioner admits an observation patient to inpatient status on a subsequent day, you may bill as follows:

Day 1: Bill the observation using an initial observation care code (99218-99220, Initial observation care, per day, for the evaluation and management of a patient ...). The place of service should be 22 (Outpatient hospital).

Day 2: Bill the visit on the hospital inpatient admission date using an initial hospital care code (99221-99223, Initial hospital care, per day, for the evaluation and management of a patient ...). The place of service should be 21 (Inpatient hospital).

Note that CPT® does not include a code for hospital admission itself. You'll choose from 99221-99223 for the admitting physician's care if he documents the elements contained within the codes (appropriate history, exam, and medical decision-making). You are not billing for the admission itself, but rather the care that your physician provides, at a level of service based on the documentation.

Also remember that if your physician is the admitting (attending) physician overseeing the patient's inpatient care for this hospital stay, you should append modifier AI (Principal physician of record) to the initial hospital care code.

Day 3: Bill the discharge management service using 99238 (Hospital discharge day management; 30 minutes or less) or 99239 (... more than 30 minutes), depending upon the time your physician spent and documented for the patient's discharge service. Again, use inpatient place of service code 21.