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Laureen: Physician Services 99221 or 99281

Q: Hi! So if you are coding for the physician services only in the ED setting and the physician is NOT an employee of the hospital – he is independent of the hospital, and the patient is admitted to the hospital do you code the level charge from 99221-99223 or 99281-99285 for the physician services? Thanks! Linda

Coding Physician Services 99221 or 99281 – Video

A: Basically, I’m taking this straight from the guidelines, and CPT if you’re using the 2013 version you’re going to page 16 and write for in the Initial Hospital Care guidelines – I literally just did a little photocopy here for you so you can see this is exactly what my book likes like, all marked up, scribbles and notes, but it’s what helps you when you’re doing your coding and things jump out at you. So it says here: “The following codes are used to report the first hospital inpatient encounter with the patient by who…the admitting physician.” So, that’s what’s key here, not whether they’re independent or not or who they work for. Are they the admitting physician of record? If they are, then they are allowed to use the initial hospital care codes. That’s what key: admitting physician.

Now, if they are not the admitting physician, what codes do they use then? Well, if their opinion is being asked they’re going to use consult codes. If not, then they’re going to use subsequent hospital care codes. That’s how that works. You basically just need to know are they admitting physician or not? Not whether they’re independent.

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2016-11-20T23:38:02+00:00

About the Author:

Laureen Jandroep
CPC, COC, CPPM, CPC-I.,Sr. Instructor for CCO.us. Resides in southern New Jersey with her husband of over 20 years Anthony and four children. They are active parents and spend most of their time these days just being parents which they love.

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