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New patient vs established patient for in patient initial hopsital care

Julie Posted Fri 29th of January, 2010 01:37:42 AM

It is my understanding that if a physician gets consulted on an inpatient after Jan 2010, we are only able to use the initial hospital care code if the physician has not seen the patient within the last 3 years (as an inpatient or outpatient). If the consult is for an established patient, we are to use a subsequent care code. Is this correct?

SuperCoder Answered Mon 01st of February, 2010 11:12:14 AM

Yes you need to code a subsequent care code 99231-99233.

Julie Posted Mon 01st of February, 2010 14:49:30 PM

Is this the case for inpatients? The CPT 2010 code book (page 14) heading "Initial Hopsital Care" has the subheading "New Or Established Patient" which leads me to think that on inpatients we can use either for the initial visit (previously coded as a consult). We have had a great deal of discussion trying to clarify this situation. Thanks for any input......

SuperCoder Answered Tue 02nd of February, 2010 11:01:09 AM

In case of inpatient service, the "initial hospital care" codes (99221 - 99223) can be used both for new and established patients. But remember, this is allowed only for the "initial / first visit" by a physician. And when billing for initial inpatient admission service, you should use AI modifier (to identify the admitting / primary care physician). In case of other physician's consultation provided under Inpatient condition, code 99221 - 99223, but WITHOUT modifier AI. This is to differentiate between the admitting and the consulting physician's service. When the physicians come for the 2nd or more visits under inpatient condition, code 99231 - 99233 to indicate "subsequent hospital care / visits".

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