Pulmonology Coding Alert

Question: My pulmonologist saw a Medicare patient on Thursday night while he was the attending physician. He then saw the patient again on Friday for a follow-up in the afternoon. The date of admission according to the hospital is Friday, so how should I bill for the initial day and the follow-up?


Colorado Subscriber
Answer: Reporting the first encounter depends on how the patient was registered on the initial day. If the patient was registered as an emergency department (ED) patient during the time that your pulmonologist saw her, you have the option to report an ED visit (99281-99285, Emergency department visit for the evaluation and management of a patient ...) or an outpatient consultation (99241-99245, Office consultation for a new or established patient ...), if all of the requirements for consultation have been met.

Note: If the patient meets your physician in the ED but is not registered in the ED, and your pulmonologist evaluates her, you may report the appropriate established outpatient visit code (99211-99215, Office or other outpatient visit for the evaluation and management of an established patient ...). 

If your pulmonologist admits the patient to the hospital on the same calendar date as the ED or office visit, you may only report the hospital admission service (99221-99223, Initial hospital care).
 
Beware: You can only report observation codes (99218-99220, Initial observation code, per day, for the evaluation and management of a patient ...) if the patient is formally admitted to observation and assigned an "observation" status by the hospital.

Since the patient was not admitted to the hospital on the previous calendar day, report the initial admission service for your physician's service on Friday, if the physician meets the minimum documentation requirements of the service.