Medicare Compliance & Reimbursement - 2016 Issue 3
Inpatient Coding: Achieve Seamless Inpatient Coding in 5 Easy Steps
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Article Overview
This article is a practical overview for coders and clinicians who bill hospital E/M services. It addresses common inpatient coding questions involving admission-related services, same-day office-to-inpatient encounters, modifier selection when surgery follows hospital evaluation, discharge day reporting, and when ICU encounters meet critical care criteria. The discussion is framed around CPT and CMS guidance and is aimed at helping readers recognize which hospital service category applies in different inpatient settings.
Why This Topic Matters
Hospital E/M billing can be more complex than office coding because several services may occur on the same date or during the same admission. Understanding the distinctions discussed in this article helps reduce claim denials and improves reporting accuracy for inpatient services.
Article Sections
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Where’s the ‘Admit’ Code?
Addresses whether a separate hospital admission code exists and discusses how initial hospital care is represented in CPT guidance.
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How Should We Report Two E/M Codes?
Covers same-day office and inpatient evaluation scenarios and explains how related documentation is treated for hospital care reporting.
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Do I Need A Modifier?
Discusses modifier use when a hospital evaluation is followed by surgery and how the encounter is categorized for reporting purposes.
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Who Reports the Discharge?
Explains discharge day reporting in multi-physician situations and addresses when a discharge service may not be reported.
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What Constitutes Intensive Care?
Reviews critical care concepts in the ICU setting and distinguishes them from other hospital E/M services.
What You Will Learn
- How inpatient and hospital E/M services differ from office-based E/M services
- How same-day office and inpatient encounters are generally addressed in hospital reporting
- How modifier use may relate to hospital E/M services when surgery follows evaluation
- How discharge day management is assigned in multi-physician care situations
- How critical care is distinguished from routine ICU evaluation and management
- How CPT and CMS guidance shape common hospital coding decisions
Who Should Read This
- Medical coders
- Physician office staff
- Hospital billing staff
- Physicians
- Revenue cycle professionals
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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