Fam Pract Manag. 2002 May;9(5):25.
Initial hospital care codes
Often an on-call doctor will see one of my patients and call in the admission to the hospital, but I’ll do the history and physical associated with the admission. The local Medicare carrier is denying these claims for initial hospital care, since the on-call doctor is identified as the admitting physician. As the patient’s attending physician, shouldn’t I be able to bill for the initial hospital care?
No, you should not submit the initial hospital care codes if you are not the admitting physician, even if you are the attending physician and do a history and physical during your initial hospital encounter with the patient. CPT is very clear that the initial hospital care codes (99221–99223) should be used to report “the first hospital inpatient encounter with the patient by the admitting physician.” The CPT manual states that “for initial inpatient encounters by physicians other than the admitting physician, see initial inpatient consultation codes (99251–99255) or subsequent hospital care codes (99231–99233) as appropriate.” The Medicare Carriers Manual (MCM) has similar advice: “Consider only one MD or DO to be the admitting physician, and permit only the admitting physician to use the initial hospital care codes. Advise physicians that if they participate in the care of a patient but are not the admitting physician of record, they should bill the inpatient evaluation and management [E/M] services codes that describe their participation in the patient’s care (i.e., subsequent hospital visit or inpatient consultation).”
Note that the dates of service and whether the admitting physician actually bills for the admission are not relevant to the issue of whether you, the attending physician, can bill for initial hospital care. The admitting physician can bill an initial hospital care code on the date the patient enters the facility or on another date as long as it represents “the first hospital inpatient encounter with the patient by the admitting physician.” Of course, if the admitting physician does not do the work associated with the initial hospital care codes (i.e., the history, exam and medical decision making required by CPT), he or she should not bill for initial hospital care either. In this case, the opportunity for anyone to bill for initial hospital care is lost.
Peak-flow rate and E/M
We use peak-flow meters to monitor our patients with pulmonary conditions, and we submit CPT code 94150, “Vital capacity, total (separate procedure),” in addition to the appropriate E/M code for the visit. However, I’ve heard that 94150 cannot be billed separately. Is that true?
Peak-flow rate monitoring should not be billed separately because it is an inherent part of the E/M exam, according to the April 1999 issue of CPT Assistant. Also, 94150 does not describe peak-flow measurement. You should simply code the encounter using the appropriate established-patient office visit code.
Digital nerve block and nail removal
What code should I submit for a digital nerve block done in conjunction with the removal of a fingernail or toenail?
You should submit a code only for the nail removal itself (e.g., 11730, “Avulsion of nail plate, partial or complete, simple; single”). CPT’s surgery guidelines list “metacarpal/metatarsal/digital block or topical anesthesia” as one of the services that is “always included in addition to the operation.”
Kent Moore is the AAFP’s manager for health care financing and delivery systems and is a contributing editor to Family Practice Management. These questions and answers were reviewed by members of the FPM Coding & Documentation Review Panel, which includes: Robert H. Bosl, MD, FAAFP; Marie Felger, CPC; Thomas A. Felger, MD, ABFP, CMCM; David Filipi, MD, MBA, and the Coding and Compliance Department of Physicians Clinic; Lynn Handy, CPC, LPN; Emily Hill, PA-C; Joy Newby, LPN, CPC; P. Lynn Sallings, CPC; and Susan Welsh, CPC.
Conflicts of interest: none reported.
Editor’s note: While this department represents our best efforts to provide accurate information and useful advice, we cannot guarantee that third-party payers will accept the coding and documentation recommended. Because CPT and ICD-9 codes change annually, you should refer to the current CPT and ICD-9 manuals and the “Documentation Guidelines for Evaluation and Management Services” for the most detailed and up-to-date information.
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Send questions and comments to firstname.lastname@example.org, or add your comments below. While this department attempts to provide accurate information, some payers may not accept the advice given. Refer to the current CPT and ICD-10 coding manuals and payer policies.
Copyright © 2002 by the American Academy of Family Physicians.
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