Pulmonology Coding Alert

Question: Our physician saw a patient in the office, then admitted her to the hospital. Can we bill for the office visit and the first day of admission, or do we just bill for the hospital stay? The physician also visited the patient next day in the hospital. How do we bill the visit?

Missouri Subscriber

Answer: In your case, the physician admitted the patient in the hospital on the same day she saw him in the office and saw the patient in the hospital to complete the admission process. Here, you’re looking at two face-to-face visits on the same date. However, you should only report the admission and not the office visit beforehand. You will report the appropriate initial hospital care code (99221-99223, Initial hospital care, per day, for the evaluation and management of a patient ...). The admitting physician (your pulmonologist) will be considered the “the attending physician of record” and has to use the initial services code with modifier AI (Physician of record). Absence of the AI modifier alerts the payer to the consultative nature of the service and may land you in trouble as there was no consultation involved.

According to CPT^® coding guidelines, all initial hospital care services that begin in another place of location (such as the physician’s office) should be combined and coded using the appropriate level of initial hospital care. Since the 99221-99223 code will include the E/M provided in the office, you’ll report an initial hospital care code that includes the work done in both sites of service.

If the physician again visits the patient in the hospital the next day, you can choose the appropriate subsequent hospital care codes, 99231-99233 (Subsequent hospital care, per day, for the evaluation and management of a patient ...), until the date of discharge.