Non-medicare initial inpatient admissions

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Good morning,

Generally speaking (and per Medicare), the reporting date for the admission service (99221-99223) is the date the visit actually occurs. I work in a pediatric hospital so we see a lot of commercial patient and hardly any Medicare patients. We do see a lot of Medicaid patients.

The American College of Surgeons has the following statement on one of their articles regarding inpatient admission code reporting (it is also stated in CPT)-

"For patients with insurance that follows non-Medicare CPT rules, the instructions are even more obscure. If a patient is admitted after an ED consultation and is not seen on the unit (in the intensive care unit, for example) on the date of admission, only report the outpatient consultation codes (99241–99245). If the surgeon sees the patient on the hospital unit on the date of admission, report all E/M services related to the admission with the initial inpatient admission service code (99221–99223) or initial observation care code (99221–99223)."


Can anyone clarify or give any input based on their commercial coding experience regarding the above statement? If the patient is admitted during the ED consultation, wouldn't you report the initial inpatient code? I'm a little unclear on the "unit" statement.

Thank you!
 
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