July 13, 2017

Question:
If a Medicare patient has been admitted to the hospital as an inpatient and the patient is transferred to my care 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?

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

*This response is based on the best information available as of 07/13/17.