Coding

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Billing Hospital

  • 1.  Billing Hospital

    Posted 06-11-2021 14:51
    When billing for doing hospital rounds .. what is the appropriate CPT code to use .. and is there a modifier that should be used ?

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    David PRINCIPE
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  • 2.  RE: Billing Hospital

    Posted 06-13-2021 15:45
    Hi David
    This is not a simple answer.  Depends on if you are primary attending or consulting MFM. If you are doing a delivery or antepartum care or PP care or both or all 3.

    In general, there are a number of inpatient codes that can be used - here are some very brief/general descriptors

    Initial hospital care – E&M codes (99221, 99222, 99223) used to report the first hospital inpatient encounter between the patient and admitting physician.

    Subsequent inpatient care – E&M codes (99231, 99232, 99233) used to report subsequent hospital visits.

    Hospital Discharge Day Management Services – E&M codes (99238, 99239) used to report the work performed to discharge a patient from an inpatient stay.

    Admission and Discharge Same Day – E&M codes (99234 – 99236) used to report services for a patient who is admitted and discharged from an observation or inpatient stay on the same calendar date.  Patient's stay must be a minimum of eight hours in order to bill these codes.

    There are modifiers to attach as well, again depending on what was done that day.
    I would suggest the chapter on inpatient coding in our Coding Manual available in the bookstore:
    https://www.smfm.org/product/2-smfm-2021-coding-manual
    or searching on the smfm website under coding Q&A, category 'E/M- inpatient'.  We have over the years answered > 30 questions regarding inpatient billing, and you might find more specific advice there.
    Best,
    Vanita

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    Vanita Jain, MD
    Chair, SMFM Coding Committee
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