Podiatry Coding & Billing Alert

Question: Are we allowed to report codes 99221-99223 more than once in the same day if a different physician sees the patient?

South Dakota Subscriber

Answer: You can report a code from the 99221-99223 (Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components …) range only once per day for physicians of the same group/specialty. However, you could add up the documentation for the day to determine the level of service that would fit best based on collective documentation by the physicians of the same group/specialty who saw the patient. You use these codes to report the first hospital inpatient encounter with a Medicare patient. The admitting physician adds the AI modifier (Principal Physician of Record) to indicate the services he or she is providing are distinct from other providers who may furnish specialty care. If physicians of different groups/specialties are consulted, they would also report codes from the 99221-99223 range as Medicare no longer recognizes consultation codes. These services would be reported without the AI modifier. As with the other evaluation and management (E/M) codes, you will decide the appropriate level of the initial hospital care code based upon history, examination, and medical decision-making.

For payers who don’t follow Medicare’s guidelines, only the admitting physician should use this code set. Other physicians who have initial inpatient encounters can look to initial inpatient consultation codes 99251-99255 (Inpatient consultation for a new or established patient, which requires these 3 key components …) or subsequent hospital care codes 99231-99233 (Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components …).

Important: You cannot report another E/M service along with codes 99221-99223, but if the physician sees the patient multiple times during the first day, all the documentation would be used toward the level of service you select. If the patient is admitted on a subsequent day, then the physician can report both the services.