Billing Medicare Patient Admittance

April 13, 2017

Question:
If a Medicare patient has been admitted to the hospital as an inpatient and the patient is seen by me first in the ED before they are moved to an inpatient bed, do I bill an ED visit or an initial hospital care code when surgery is not planned? I will be following the patient in the hospital.

Answer:
Since the patient has been formally admitted you would report CPT codes 99221-99223 for initial hospital care depending the documentation and medical necessity for the complexity of the patient.  Keep in mind, Medicare does not pay for inpatient or outpatient consultations.

*This response is based on the best information available as of 04/13/17.

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