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What is the CPT code to be reported when physician directly admits a patient to Hospital from the Office?


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. The initial hospital visit procedure codes are used for the first time the admitting physician sees the patient in the hospital. For example: If patient is seen in physician's Office on Day 1 and on the same day physician admits the patient directly to the Hospital only an Office (99201-99215) should be reported on Day 1. Again, on Day 2 if physician sees the patient in Inpatient setting of the Hospital i.e for the first time physician sees the patient in Hospital inpatient setting the service can be reported as an initial inpatient Hospital visit (99221-99223).

The service provided on Day 1 is an office visit. Bill the initial visit the first time the physician see the patient in the hospital. As the physician did not see the patient in the inpatient facility on Day 1, an initial inpatient service should not be billed.

Reference: http://www.wpsmedicare.com/part_b/resources/provider_types/2009_0706_emfacility.shtml


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