Billing Hospital Care codes

ELBrock

Networker
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The patient is in her second trimester and is seen in the ER for flank pain. The ER Doctor calls our on-call OB doctor, who agrees to admit the patient to the women's center.
So our Doctor is the admitting doctor, but this is all done via phone.
The patient is transferred to the women's center and admitted as an inpatient and attended to by the nurses. The nurses are following all orders from the physician via phone, and notes verify the doctor is being updated on all changes.
The doctor comes in the next day to see patient and discharges her home.
I'm wanting to code this with 99221, 99238.
It appears the history/exam were not all re-done, since the records came over from the ER with a diagnosis of kidney infection in second trimester.
Can those ER records be used to level the initial hospital care code (99221,99222, or 99223), since that information was used to admit the patient? Or since that was a different location and different doctor, can we not?
Or am I off the mark, and we wouldn't even be using initial hospital care codes in this situation? Our doctor is a hospitalist for the Women's Center.
Thank you very much!
 

ELBrock

Networker
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I think I may have answered my own question. Since the ER visit and the admit occurred on the same DOS, then the components from the ER visit can be used in determining the level of the IP admit by the admitting provider, since all E/M services provided on the same day, and in conjunction, with the IP admit are considered part of the initial hospital care. Can someone clarify that I have that correct?
 

katemae84

Networker
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Sanford, ME
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No, that's not correct if you're coding for the OB provider's professional services. Your OB doctor can only use their documentation (or that of a colleague in the same practice & specialty), they can't use the ER doctor's notes to substantiate a charge, and they cannot bill a 99221, 99222 or 99223 for advising the patient be admitted during a phone call since there was no face-to-face visit. What you will be able to bill for is whatever service they documented during the face-to-face with the patient when the provider finally saw them the next day. And you can't bill 99221 - 99223 on the same day as a discharge either.
 
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