Medicare Compliance & Reimbursement - 2007 Issue 5
Don't Mistake 99221-99223 for Admission Codes
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Article Overview
This case-based article is for coders and billing staff who handle evaluation and management services across office and inpatient settings. It discusses how hospital admission timing, the first face-to-face inpatient encounter, and place-of-service reporting affect whether services are treated as office care or initial hospital care. The article also addresses same-day service handling and the relationship between office visits and subsequent inpatient care.
Why This Topic Matters
Incorrectly treating hospital initial care as an admission code or mismatching service date and place of service can lead to claim errors and payment issues. The article helps readers understand how to align documentation, site of service, and E/M reporting when care begins in the office and continues in the hospital.
Article Sections
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Case study: office visit followed by hospital arrival
A scenario is presented in which a physician evaluates a patient in the office and arranges direct hospital admission, but the first inpatient face-to-face encounter occurs later.
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Dates must correspond
This section discusses how the timing of the office encounter and the first inpatient encounter affects reporting across the two service dates.
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Patient status, POS matter
This section covers the relationship between patient status, place of service reporting, and the broader distinction between office and inpatient E/M services.
What You Will Learn
- How the timing of office and inpatient encounters affects E/M reporting
- Why the first face-to-face hospital encounter matters for inpatient care reporting
- How place of service reporting relates to inpatient E/M claims
- How same-day office and inpatient services are handled at a high level
Who Should Read This
- Medical coders
- Hospital billing staff
- Physician office billing staff
- Compliance staff
- Revenue cycle professionals
Codes Discussed
Code Ranges Discussed
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