Must Hospital Admit Codes and Admission Show Same DOS?
Posted on 31. Jul, 2009 by Editor in Hot Coding Topics
Overlook this rule, and risk leaving rightful E/M dollars on the table.
When the physician admits a patient from another site of service on day 1, but doesn’t see the patient in the hospital until day 2, choosing the date of service for your claim can raise some questions. Knowing the answers not only keeps your date of service accurate, but also may add to your bottom line.
Consider the following scenario offered by Dolly Cooper, CMC, and Brenda Mantia, CMC, who work with a 10-physician practice in Shreveport, La.
Scenario: The patient is admitted at 11:57 p.m., May 1, to the physician. The physician sees the patient in the hospital for the first time at 2:00 a.m. on May 2.
What would you do? Would you choose May 1 or May 2 as the date of service (DOS) for the physician’s visit?
Match Your DOS Choice to the Authorities’
Solution: May 2 is the correct choice. The DOS for the physician’s E/M is the date when the physician “provided the face-to-face inpatient encounter with the patient in the hospital,” says Karna Morrow, CPC, RCC, a consultant with Coding Strategies Inc. in Powder Springs, Ga.
Support: The AMA’s July 2007 CPT Assistant clarifies, “From the reporting physician’s perspective, the hospital admission services (99221-99223 [Initial hospital care, per day, for the evaluation and management of a patient …]) are reported on the day they are performed, which may not be the date of hospital admission,” Morrow points out.
The key here is that so-called “admit” codes 99221- 99223 don’t say anything about admission in their descriptors. They instead describe initial hospital care and require a face-to-face visit in the inpatient setting.
Bonus tip: Only the admitting physician should report 99221-99223.
See How Same-Date, 2-Date Coding Differs
The date of service for the initial hospital care is also important in determining proper...
If you've already signed in and are still seeing this screen, click here to refresh the page.
- Free updates on CPT, ICD-9, HCPCS, Medicare, NCCI edits, and ICD-10.
- Discounts on 3rd party offers
Loading ...
maureen
14. Aug, 2009
good article about admission coding…question. I know that we should code the admit when the MD provides the service…however, if the inpatient registration has May 1 and you submit admit codes on May 2 often these admit charges will be denied b/c the admit date of service and the actual date the service was provided are different. can you address?
Deborah Dorton, JD, MA, CPC
02. Sep, 2009
It sounds like the payer isn’t treating 99221-99223 as the initial hospital visit codes that they are. Billing experts recommend appealing such denials and explaining to the payer that there is no requirement for 99221-99223 to be billed on the admission day. Stress the code definitions, which state “initial hospital care.” You also can cite the July 2007 CPT Assistant article quoted above, which spells out that it is correct to report 99221-99223 on the date of the face-to-face service, which may not be the same as the hospital admission date. Best of luck!
Deborah Dorton, JD, MA, CPC
Editor, The Coding Institute
Chris
25. Oct, 2009
I have a question that I have seen answered multiple times differently. When a patient is seen in the office and sent to the hospital with orders, however the physician does not come to the hospital until the next day, can the physician bill for an initial hospital visit on that date? I have seen where the physician needs to be physicallty present at the hospital on this date to have the face to face encounter allowing him to bill for the admission and then I have read where he can bill even if he didn’t come to the hospital that day. I have read that he could bill for the inpatient admission on the morning he does come in to see the patient and the office visit would be billed the day he was admitted. My problem is I have a physician coming into the hospital the next am and backdating an entry for the day prior (office visit day and hospital admit date). He only writes “H&P” for this date, however the H&P is not dictated until the actual day the physician comes to the hospital to see the patient. What is he trying to accomplish by doing this? To me, it is very suspicious and makes me think that he is not allowed to bill for the hospital admission unless he sees the patient face to face in the hospital. Can someone help me with this?
Jenny Berkshire, CPC, CEMC
04. Nov, 2009
Another question: In the teaching setting, if the resident admits a patient on day one, but the teaching physician does not see or document until day two, which day is reported by the TP?