Primary Care Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.



Question: A patient came into the office for an unscheduled visit, during which an EKG was performed and blood was drawn. The EKG showed an infarction and, therefore, the patient was admitted to the hospital. I am not sure if I can code for the emergency office visit in addition to the hospital admission. When filling out the claim, I coded only the EKG and the blood tests because I understand we cannot code for two evaluation and management services on the same day. Can a modifier be added because of the time our physician spent with that patient?

Indiana Subscriber


Answer: Your understanding of how to code this case is correct, says Cynthia DeVries, RN, BSN, CPC, a coding and reimbursement coordinator for Lee Physicians Group, a 140-provider, multispecialty practice in Ft. Myers, Fla. In essence, billing for both the office visit, 99058 (office services provided on an emergency basis) and the hospital admission (one of the codes in E/M series 99221-99223 [initial hospital care]) on the same date would be charging for the same service twice evaluating symptoms and diagnosing the heart attack. Billing both services, with or without a modifier, would not be appropriate.

The best way to report your physicians services and to receive reimbursement appropriate to the work done is to bill for the EKG, 93000 (electrocardiogram, routine ECG with at least 12 leads; with interpretation and report) and blood draw (i.e. 36415, routine venipuncture or finger/heel/ear stick for collection of specimen[s]) that was done in the office.

In addition, you will want to make sure that the code assigned for the hospital admission also reflects the level of care provided in the office setting. All three levels of the hospital admission code describe the key components to be considered when assigning the correct code including the complexity of the medical decision-making.