Getting Reimbursed Adequately for Two Hospital Visits in One Day
Published on Mon Jun 01, 1998
Sometimes a pediatrician must visit a hospitalized child more than once a day. But CPT specifically states that all hospital care codes are per day, not per visit. Mary Joyce, business manager for Westbury Pediatrics, St. Charles, MO states the problem succinctly. Is there a way to code a second inpatient hospital visit for the same day and have it reimbursed by insurance? Using a -25 modifier doesnt seem to work. It is not unusual for a pediatrician to have to make an a.m. and p.m. visit to the hospital to care for an ill child, writes Joyce.
The short answer to this question is no, there is no code for the second visit. You cant code a hospital visit to the same patient more than once in one day, says Charles M. Vanchiere, MD, FAAP, chair of the RBRVS PAC of the AAP and CEO of Childrens Clinic of SW Louisiana in Lake Charles. You have to just code for one visit.
However, you have options for what code to use, to get reimbursed more fairly. You can go up to the next code level, says Vanchiere. But you shouldnt do this automatically, just because you have visited the patient twice. Whether you decide to convert your two second-level visits to one third-level visit, for example, depends on the work you do during those two visits, the coding expert stresses. Obviously, time is something of a factor here, since you are visiting the patient two times. It can be time-related, he notes. But it should be necessary time. It cant be just because youre in the hospital anyway.
The hospital care codes are as follows. All are on a per day basis.
(Note: In the code descriptions before typical time spent applies to time spent at the bedside and on the patients hospital floor or unit.)
Initial (Admitting) Hospital Care Codes
CPT 99221 - for a detailed or comprehensive history, a detailed or comprehensive examination, and medical decision-making that is straightforward or of low complexity. Typical time spent: 30 minutes. (Example: admission of an 18-month-old child with 10-percent dehydration.)
99222 - for a comprehensive history, a comprehensive examination, and medical decision-making of moderate complexity. Typical time spent: 50 minutes. (Example: admission for an 8-year-old febrile patient with chronic sinusitis and severe headache, responsive to oral antibiotics.)
99223 - for a comprehensive history, a comprehensive examination, and medical decision-making of high complexity. Typical time spent: 70 minutes. (Example: admission for a 9-year-old with vomiting, dehydration, fever, tachypnea, and an admitting diagnosis of diabetic ketoacidosis.)
Subsequent Hospital Care Codes
These include reviewing the medical record and the results of diagnostic studies and changes in the patients status since the last assessment by [...]
