Coding & Documentation
Cindy Hughes, CPC
Hospital admission following an office visit
Q When a physician sees a Medicare patient in the office and, in the course of the office visit, determines that hospital admission is required, how should this be coded? Is it necessary to visit the patient again in the hospital after having seen him or her in the office, or is the time spent with the patient in the office sufficient to fulfill the requirements for the admission code?
A To submit an inpatient care code, you have to see the patient in the hospital. If you provide the office visit and see the patient in the hospital later that day, you'll be paid only for the inpatient care code, because Medicare states that "All services provided by the physician in conjunction with that admission are considered part of the initial hospital care when performed on the same date as the admission." If you don't see the patient in the hospital until the next date, you will be paid for both the evaluation and management visit and the inpatient care, because Medicare also states that "Carriers pay both visits if a patient is seen in the office on one date and admitted to the hospital on the next date, even if fewer than 24 hours has elapsed between the visit and the admission."