I don't necessarily agree with all of this.
CPT describes the codes 99221-99223 as being used to report the first hospital inpatient encounter by the admitting physician. CPT goes on to explain that for initial inpatient encounters by physicians other than the admitting physician, see initial inpatient consultation codes (99251-99255) or subsequent hospital care codes (99231-99233).
The only time you'd use these initial hospital care codes for physicians other than the admitting is when the patient's payer (i.e. Medicare) does not accept the consult code, and Medicare instructs us to use the 99221-99223 as a substitute. It's correct that you use the -AI modifier to differentiate between the attending's visits and the consultant's. Not all payers follow this exception, so to use these codes for the 'first visit' in the inpatient setting by any other provider wouldn't be appropriate, particularly if a consult hasn't been called. Remember, transfer of care is not a consultation.
Bottom line regarding transfer of care: If the admitting provider is handing off the case, and not asking for an opinion, I'd bill from the 99231-99233 range. If the patient is not currently admitted with inpatient status, (say, in the ED), and your provider comes into the facilty and admits the patient under his care, then the patient status has changed, and your provider is the admitting provider...you'd bill 99221-99223.
These kinds of scenarios are what keep us employed!
Pam Brooks, MHA, CPC, PCS, COC
Dover, NH 03820
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