Hammon Marilyn
University of Oklahoma Health Science Center, USA.
J Okla State Med Assoc. 2005 Jun;98(6):258-9.
How should a physician code and bill for services when a patient is seen in the clinic and then is directly admitted to the hospital? The correct answer is not as straightforward as it might at first seem because of needing to understand what amounts to the "fine print" in the Current Procedural Terminology (CPT) book code description. It also depends on whether or not the physician subsequently had face-to-face contact with the patient in the hospital. According to the CPT book, "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 (E/M) provided by that physician in conjunction with that admission are considered part of the initial hospital care when performed on the same date as the admission. The inpatient care level of service reported by the admitting physician should include the services related to the admission s/he provided in the other sites of service as well as in the inpatient setting." At first, this wording could lead physicians and coders to conclude that their only recourse is to "roll up" the level of service provided in the clinic with the additional documentation necessary to admit a patient to the hospital to determine the code for "Initial Hospital Care", CPT 99221-99223. However, it has been noted that the description in the CPT book under initial hospital care has "fine print" in the statement the "codes are used to report the first hospital inpatient encounter with the patient by the admitting physician." "Encounter" is commonly understood to mean a "face to face" encounter between the physician and patient in the hospital setting. But, what if the physician does not go to the hospital to see the patient on the same date that s/he saw the patient in the clinic? Because a face to face encounter in the hospital did not occur, it would be inappropriate to use any of the "Initial Hospital Care" CPT 99221-99223 codes. Rather, the services of the clinic visit should be billed as "new" or "established" patient office visit on the date seen and the initial hospital service would be billed on a following date when the physician actually sees the patient in the hospital setting.
当患者在诊所就诊后直接被收治入院时，医生应如何对服务进行编码和计费？正确答案并非像乍看起来那么简单直接，因为需要理解现行程序术语（CPT）手册代码描述中的“细则”。这还取决于医生随后是否在医院与患者进行了面对面接触。根据CPT手册，“当患者在另一服务地点（如医生办公室）的诊疗过程中被收治入院时，该医生在此次收治过程中提供的所有评估和管理服务（E/M），若与入院在同一天进行，则被视为初始住院护理的一部分。收治医生报告的住院护理服务级别应包括其在其他服务地点以及住院环境中提供的与入院相关的服务。”起初，这段话可能会让医生和编码人员得出结论，他们唯一的办法是将诊所提供的服务级别与收治患者入院所需的额外文件“合并”起来，以确定“初始住院护理”（CPT 99221 - 99223）的代码。然而，需要注意的是，CPT手册中关于初始住院护理的描述在“这些代码用于报告收治医生与患者的首次医院住院接触”这句话中有“细则”。“接触”通常被理解为医生与患者在医院环境中的“面对面”接触。但是，如果医生在诊所见到患者的同一天没有去医院看望该患者会怎样呢？由于在医院没有发生面对面接触，使用任何“初始住院护理”CPT 99221 - 99223代码都是不合适的。相反，诊所就诊服务应在就诊当天按“新”或“复诊”患者门诊就诊进行计费，而初始医院服务应在医生实际在医院环境中见到患者的后续日期进行计费。
