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Initial and Subsequent Hospital Inpatient codes

Lynne Posted Thu 25th of October, 2012 14:55:25 PM

Do you have to have an Intial Hospital care code from range (99221-99223) to bill a Subsequent Hospital Care code for the first inpatient encounter by the admitting physician?

The patient was admitted into the hospital on 10/09/12 and the initial visit was coded as (99232) a subsequent code on the admit date. When asked about this she stated there was not enough documentation to bill an initial visit. So we asked what guideline this decision is derived from and the coder quoted from CMS.
"TAKEN FROM CMS MANUAL SYSTEM PAGE 3, http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R2282CP.pdf"

But when reading this page it reffered to the consultation payments.

SuperCoder Answered Fri 26th of October, 2012 15:58:49 PM

The subsequent hospital care (99232) cannot be coded for the initial visit on the admit date. If documentation supports to code atleast the lowest level of initial hospital care (99221), you can code 99221. If enough documentation is not there to meet the criteria for 99221, the chart cannot be coded.

You can request your physician to send complete documentation to code it.

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