Coding for a Hospital Visit

Question:

I was at your conference this past weekend and I was wondering if you could clarify something for me. When a physician sees a Medicare patient in the hospital, and it is their first time seeing the patient however they are NOT the admitting physician, they can only bill a subsequent visit or consult code depending on what the payor allows and documentation correct? Thank you for your assistance.

Answer:

If the physician is seeing the patient in the hospital for the first time even though he/she is not the admitting physician based on appropriate documentation, an initial hospital visit code (99221-99223) can be billed as long as all three key component requirements are met.  If the minimum requirement for the initial hospital care code is not met a subsequent hospital visit can be reported.  Keep in mind Medicare does not pay for consultations.

*This response is based on the best information available as of 06/02/22.