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Family Practice Coding Alert

Reader Questions:
Clear Confusion About Same Day Office and Hospital Visits

Question:  We have several patients that we see in the office and then they are admitted to the hospital on the same day later in the afternoon. Can we bill for the office visit and the first day of admission or do we just need to bill for the hospital stay? Please let me know the correct way to do this.

Illinois Subscriber

Answer:  The solution to your query lies in understanding when your physician saw the patient in the hospital.

Same day: If your physician performs face-to-face hospital care on the same day as he saw the patient in the office (two face-to-face same day visits), you should use only the initial hospital care code (99221-99223).Since the 99221-99223 code will include the evaluation and management provided in the office, you may have a higher level of initial hospital care than if you were considering the hospital services alone.

According to CPT® initial hospital care guidelines, “When the patient is admitted to the hospital as an inpatient in the course of an encounter in another site of service (e.g., hospital emergency department, observation status in a hospital, office, nursing facility) all evaluation and management services provided by that physician in conjunction with that admission are considered part of the initial hospital care when performed on the same date as the admission. The inpatient care level of service reported by the admitting physician should include the services related to the admission he/she provided in the other sites of service as well as in the inpatient setting.”

Different days: If, however, your physician does not see the patient in the hospital until the next day (office visit and admission on day 1; first face-to-face initial hospital care on day 2), you would charge the office visit (99201-99215) on day 1 and the initial hospital care (99221-99223) on day 2. Per CPT®, initial hospital care codes (99221-99223) are used to report “the first hospital inpatient encounter with the patient by the admitting physician.” These are initial face-to-face care codes, not admission codes as they are commonly called.