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Direct admit from office

  1. #1
    Location
    Lancaster,PA
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    75
    Smile Direct admit from office
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    Our physician saw a patient in our office as a 99215 then was a direct admit from our office to the hospital. In reviewing the H&P from the hospital that also is a high level 99223. My question is which E&M is billable for same day service
    Thank You

  2. #2
    Location
    Dover Seacoast New Hampshire
    Posts
    1,971
    Default
    Since you can bill only one E&M visit per day for the same physician, the RVUs are higher for the admission, so from a fiscal perspective, that's what most providers do. Since your H&P meets a 99223, you can bill that; however, you could combine the documentation from both visits to arrive at your initial hospital visit code.

  3. #3
    Location
    Milwaukee WI
    Posts
    4,466
    Default CPT Guidelines
    This question (or one similar) has been asked and answered several times previously.

    Please read the Guidelines in CPT 2010 Professional Edition, page 14 under Initial Hospital Care.

    F Tessa Bartels, CPC, CEMC

  4. #4
    Location
    North Carolina
    Posts
    3,126
    Default
    Also...

    Contractors pay for an initial hospital care service if a physician sees a 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.

    http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf

    30.6.9.1

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