patient admitted directly from physician's office, report initial hospital care cpt/hcpcs

by Amparo Wuckert 9 min read

CPT code 99221, 99223, 99222 and 99233 – Inpatient …

1 hours ago  · F. Initial Hospital Care Visits by Two Different M.D.s or D.O.s When They Are Involved in Same Admission Physicians use the initial hospital care codes (codes 99221-99223) to report the first hospital inpatient encounter with … >> Go To The Portal


When the patient is admitted to inpatient hospital care for less than 8 hours on the same date, then Initial Hospital Care, from CPT code range 99221 – 99223, shall be reported by the physician. The Hospital Discharge Day Management service, CPT codes 99238 or 99239, shall not be reported for this scenario.

If patient is directly admitted to the Hospital from Office only an Office visit should be reported but an Initial Inpatient Hospital visit (CPT 99221-99223) can also be reported on the day on which physician first sees the patient in the Hospital.

Full Answer

What is the CPT code for initial hospital care?

When a patient has been admitted to inpatient hospital care for a minimum of 8 hours but less than 24 hours and discharged on the same calendar date, Observation or Inpatient Hospital Care Services (Including Admission and Discharge Services), from CPT code range 99234 – 99236, Reporting Initial Hospital Care Codes

When a patient is admitted to a hospital directly from office?

When a patient is admitted to a hospital directly from an office report a code from the Initial Hospital Care Subcategory. Determine if the following statement is true or false. The anticoagulant management codes can be reported in the outpatient and inpatient setting.

When is a consultation code reported in the emergency room?

When a patient and/or the family initiates a consultation (instead of a physician initiating it), a consultation code is reported. Which of the following statements is NOT true in the emergency room setting?

When do carriers pay initial hospital care and discharge codes?

C. Initial Hospital Care and Discharge on Same Day Carriers pay only the initial hospital care code when a patient is admitted as an inpatient and discharged on the same day. They do not pay the hospital discharge management code on the date of admission.

What is the difference between 99238 and 99239?

The only difference between a 99238 and a 99239 is that a 99239 is greater than 30 minutes spent on discharge and a 99238 is thirty minutes or less spent on discharge. Please reference the AMA's CPT 2018 Standard Edition as the definitive authority in CPT® coding, available below and to the right from Amazon.

What is a 99223 CPT code?

CPT 99223 is defined as: Initial hospital care, per day, for the evaluation and management of a patient, which requires these three key components: A comprehensive history. A comprehensive exam. Medical decision making of high complexity.

What is the HCPCS code 99221?

CPT code 99221 (30 minutes) Describes the first inpatient encounter with the patient. Detailed or comprehensive history and exam. Straightforward or low-level medical decision-making.

What is the CPT code 99220?

Established Patient Initial Hospital Observation Care ServicesCPT® 99220, Under New or Established Patient Initial Hospital Observation Care Services. The Current Procedural Terminology (CPT®) code 99220 as maintained by American Medical Association, is a medical procedural code under the range - New or Established Patient Initial Hospital Observation Care Services.

What is the difference between 99223 and 99233?

If a doctor is asked to come in and "consult" and it fits the rules for billing a true consult, then yes you would bill a 99221-99223. However, if the doctor is "consulting" on a problem they will be managing or currently manage then you should bill a 99231-99233.

What is the CPT code 99233?

What is CPT Code 99233? CPT code 99233 is assigned to a level 3 hospital subsequent care (follow up) note. 99233 is the highest level of non-critical care daily progress note. When it comes to 99233 documentation is critical, however understanding of the documentation required is even more critical.

What is the difference between 99221 and 99222?

The key difference between medical CPT code 99221 and 99222 is severity. In CPT code 99221, the severity of hospitalisation is comparably low, while the severity of medical hospitalisation in CPT code 99222 is fairly high.

What is the CPT code 99211?

CPT® code 99211 is defined by the 2011 CPT Standard Edition manual as: "Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician.

What does CPT code 99242 mean?

CPT® Code 99242 - New or Established Patient Office or Other Outpatient Consultation Services - Codify by AAPC. CPT. Evaluation and Management Services. Consultation Services. Office or Other Outpatient Consultation Services.

What is the CPT code 99218?

Initial Observation Care codes (99218 – 99220) are used to report E&M services provided to patients designated/admitted as “observation status” in a hospital to determine whether they warrant admission, transfer, or discharge. Only the physician initiating observation status may report these codes.

What is the CPT code 99217?

A: CPT code 99217, observation care discharge day management, is used for billing when a patient is discharged from observation care on a date other than the date he or she was placed in observation status.

What is CPT code G0378?

G0378 is a valid 2022 HCPCS code for Hospital observation service, per hour or just “Hospital observation per hr” for short, used in Medical care.

General Information

CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

CMS National Coverage Policy

Title XVIII of the Social Security Act, Section 1833 (e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period..

Article Guidance

Medicare rules and regulations regarding acute care inpatient, observation and treatment room services are outlined in the Medicare Internet-Only Manuals (IOMs).

ICD-10-CM Codes that Support Medical Necessity

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim (s) submitted.

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.

Can you bill E&M for same physician?

Since you can bill only one E&M visit per day for the same physician, the RVUs are higher for the admission, so from a fiscal perspective, that's what most providers do. Since your H&P meets a 99223, you can bill that; however, you could combine the documentation from both visits to arrive at your initial hospital visit code.

Do E/M providers pay for the same doctor?

They do not pay for both E/M services. Also, they do not pay for an emergency department visit by the same physician on the same date of service. When the patient is admitted to the hospital via another site of service (e.g., hospital emergency department, physician's office, nursing facility), all services provided by the physician in conjunction ...