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Thread: admission

  1. #1

    Default admission

    AAPC: Back to School
    Help! My Doctor saw patient in office this morning for scheduled follow up care and at that time he decided to admit him to hospital. He coded 99221 initial hospital care. I am confused on what facility to bill and if this is the correct way to bill this at all. Can anyone offer any advice?

  2. #2


    This is from CMS - -

    A. Initial Hospital Care From Emergency Room
    Contractors pay for an initial hospital care service or an initial inpatient consultation if a physician sees his/her patient in the emergency room and decides to admit the person to the hospital. They do not pay for both E/M services. Also, they do not pay for an emergency department visit by the same physician on the same date of service. When the patient is admitted to the hospital via another site of service (e.g., hospital emergency department, physician’s office, nursing facility), 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.

    B. Initial Hospital Care on Day Following Visit
    Contractors 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.

    So, he can follow scenario A above and bill the 99221 if he prefers and the place of service would be the hospital. Or, if he does a more extensive visit with the patient the following day in the hospital, he could bill an office visit for the day of the admit and his initial hospital visit the next day (per scenario B). When admitted straight from the office, I usually bill the initial hospital visit.

    Lisi, CPC

  3. #3
    Join Date
    Apr 2007
    Milwaukee WI

    Default Was this postop ?

    If this was in the postoperative global period you may not be able to bill at all ... depends on the reason patient was readmitted and the payer. Medicare is getting very strict about this ... only return to OR gets paid in the global period.

    In general, if the patient went straight to the hospital and was admitted under your doctor's service, then just bill the Initial Hospital Visit. You can use office visit documentation in support of your level.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  4. #4

    Default code where you landed

    The best answer I got to this was given at a McVey Seminar I attended in June of this year. I asked a similar question. If the patient is admitted from the office, do you code the office visit or the admission. The instructor said to "code where you landed". If the patient ended up only going to the ER and being treated and released- ER. If the patient was only admitted to observation- choose the correct level of obs....etc.

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