Primary Care Coding Alert

Question: A patient presents to the office, and the physician determines she needs to be admitted to the hospital that day. What is the proper way to bill for this? Should we use an E/M code for the office visit, a hospital admission code, or both?

Georgia Subscriber  
Answer: Report the appropriate hospital admission code, 99221-99223, initial hospital care, new or established patient. You can bill only one E/M code in this situation, but you can use the E/M level of the office visit to raise the level of the hospital admission code. When an office visit occurs on the same day as a hospital admission, the services provided by the physician in the office are considered part of the initial hospital care. For example, if the doctor sees the patient in the office for a level-three visit (e.g., 99213, office or other outpatient visit for the evaluation and management of an established patient) and admits the patient to the hospital at a level-one (99221, initial hospital care, per day, for the evaluation and management of a patient), the office visit should allow you to bill a level-two (99222) hospital admission code.
 
The coding differs if the physician does not have an inpatient encounter with the patient on the same day of the admission. For example, the doctor sees the patient in the office on Monday and admits him or her to the hospital the same day. But the doctor does not see the patient in the hospital until Tuesday morning. In this case, report the appropriate E/M office visit on Monday, and report the appropriate initial hospital care code on Tuesday the date the admitting physician had the first hospital encounter with the patient. You cannot add the E/M outpatient visit code to the hospital admission code because you have already billed separately for the office visit.