Wiki Admit questions

[dsmith06351]

I have a couple of questions on admits.

The doctor admits a patient directly from the office and the patient is not seen in the hospital by this doctor until the next day, how would you code the level of the admit? All I have is the office notes so would I code based on those notes only? What do you use if the level of service for the admit does not meet the lowest code? ex. 99221 must meet a detailed history a detailed exam and a straightforward MDM, but my documentation is an epf history a detailed exam and a low MDM.

Thanks for any help

Denise Smith CPC-A

 

[cheermom68]

admit

You cannot code the initial inpatient visit until the next day when the physician actually saw the patient in the hospital. You can charge an office visit for the first day and then on the day of the initial inpatient visit you would charge the 99221,99222 or 99223 depending on the documentation. Different carriers want different codes if there is not enough for a 99221. Some want 99499 with report, some want 99221-52 you would have to contact the individual carrier to find out.