Don’t Make Mistakes On Admission Codes

As you know, a hospital admission requires face-to-face service. However a common dilemma that many medical billers find themselves in is when a surgeon “admits” the patient and then isn’t present when the patient arrives at the hospital to check in.
In most cases the physician will dictate the history and physical (H&P) over the phone to the hospital and then send the patient over, however the dilemma for the medical billing occurs over the fact that the face-to-face interaction between physician and patient doesn’t occur until the following day.

First of all, your dates must correspond. If the physician doesn’t see the patient in the hospital that day (performing history, exam and medical decision-making face-to-face the following day), you should report the office visit on the date the physician saw the patient in the office and then bill an initial in-hospital code (99221-99223, Initial hospital care, per day, for the evaluation and management of a patient…) the next day. Since the date of admission to the hospital and the first hospital visit by the physician will not correspond, but this is the proper coding for your scenario. The first day the physician sees the patient in the hospital becomes the initial hospital admission, not the actual day of admission to make your medical billing flow.

Remember that codes 99221-99223 are not admit codes even though they are often referred to as such. This code set is actually described as initial hospital care and do not necessarily have to correlate to the admit date.

View all Articles by: Kathryn E, CCS-P - Retired