Initial H&P by other than admitting MD
I just found this article on the subject, any thoughts?
http://www.aafp.org/fpm/20020500/coding.html
Initial hospital care codes
Q Often an on-call doctor will see one of my patients and call in the admission to the hospital, but I'll do the history and physical associated with the admission. The local Medicare carrier is denying these claims for initial hospital care, since the on-call doctor is identified as the admitting physician. As the patient's attending physician, shouldn't I be able to bill for the initial hospital care?
A No, you should not submit the initial hospital care codes if you are not the admitting physician, even if you are the attending physician and do a history and physical during your initial hospital encounter with the patient. CPT is very clear that the initial hospital care codes (99221-99223) should be used to report "the first hospital inpatient encounter with the patient by the
admitting physician." The CPT manual states that "for initial inpatient encounters by physicians other than the admitting physician, see initial inpatient consultation codes (99251-99255) or subsequent hospital care codes (99231-99233) as appropriate." The
Medicare Carriers Manual (MCM) has similar advice: "Consider only one MD or DO to be the admitting physician, and permit only the admitting physician to use the initial hospital care codes. Advise physicians that if they participate in the care of a patient but are not the admitting physician of record, they should bill the inpatient evaluation and management [E/M] services codes that describe their participation in the patient's care (i.e., subsequent hospital visit or inpatient consultation)."
Note that the dates of service and whether the admitting physician actually bills for the admission are not relevant to the issue of whether you, the attending physician, can bill for initial hospital care. The admitting physician can bill an initial hospital care code on the date the patient enters the facility or on another date as long as it represents "the first hospital inpatient encounter with the patient by the admitting physician." Of course,
if the admitting physician does not do the work associated with the initial hospital care codes (i.e., the history, exam and medical decision making required by CPT), he or she should not bill for initial hospital care either. In this case, the opportunity for anyone to bill for initial hospital care is lost.
