Otolaryngology Coding Alert

Question: If a physician sees a patient and admits him on the same day, how should he bill? Can he bill for the office visit or would he bill as an inpatient consultation?

Kansas Subscriber
Answer: Neither an office visit nor an inpatient consultation should be billed. Instead, the only E/M service that may be billed is an inpatient admission, 99221-99223. If the patient was admitted by another physician and then seen by the otolaryngologist, use an appropriate inpatient consult code, 99251-99255.
 
An established patient visit (for the earlier office visit) and an inpatient admission can be billed on the same day only when the otolaryngologist saw the patient for two entirely unrelated reasons. For example, the otolaryngologist sees the patient in the morning for rhinitis but, later the same day, admits the patient to the hospital for unrelenting vertigo. Even so, the claim will likely be denied initially but should be paid on appeal if appropriate documentation is submitted.
 
In most other circumstances, only the admission may be billed. But if the otolaryngologist carefully documents time spent with the patient during both the admission and the earlier visit, it may be possible to bill for prolonged services (99356-99357) with the admission. It is also possible that the review of notes from both the visit and the admission may permit the billing of a higher-level admission if the higher level is supported in the documentation.