Admitting From the Office

January 1, 2008

I have a patient disputing a 99219 charge. We saw the patient in the office but admitted him directly to the hospital. We charged a 99219 for hospital admission. However, the patient was not seen at the hospital bedside; the physician dictated the history and physical before the patient left our office.

Question: I have a patient disputing a 99219 charge. We saw the patient in the office but admitted him directly to the hospital. We charged a 99219 for hospital admission. However, the patient was not seen at the hospital bedside; the physician dictated the history and physical before the patient left our office.

Answer: According to CPT’s introductory notes for initial hospital care, “When the patient is admitted to the hospital as an inpatient in the course of an encounter in another site of service (e.g., physician’s office) all evaluation and management services provided by that physician in conjunction with the admission are considered part of the initial hospital care when performed on the same date as the admission.”

In other words, it does not dictate that anything needs to be done or documented in the office or hospital, just that whatever you did can be counted toward the admit.

Perhaps you should call in someone from the hospital coding office to offer an objective opinion.