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POLICY

• When a physician admits a patient to the hospital in the course of an encounter initiated at another site (e.g., physician office, hospital emergency department, observation status in a hospital, nursing facility), all E/M services provided by that physician on the same date as the admission are considered part of the initial hospital care. The code selected for the inpatient admission should reflect the level of service initiated at the other site(s) of service and the services provided in the inpatient setting. The physician should report only the initial hospital care code.

• When a physician admits a patient to the observation area in the hospital in the course of an encounter initiated at another site (e.g., physician office, hospital emergency department, observation status in a hospital, nursing facility), all E/M services provided by that physician on the same date as the admission are considered part of the initial observation services. The E/M code selected for the observation services should reflect the level of service provided at the other site(s) of service and the services provided in the observation area in the hospital. The physician should report only the observation care code.

• When the same physician provides hospital inpatient care (including hospital admission, inpatient care, and/or hospital discharge) to a patient on the same date as admission or re-admission to a nursing facility, the nursing facility E/M services may be reported separately.

• When the same physician provides observation services (including admission and/or discharge) to a patient on the same date as admission or re-admission to a nursing facility, the nursing facility E/M services may be reported separately.

Note: The reference above to the "same date of service" refers to the same calendar date, not to a 24-hour period. If services are provided on different calendar dates, the services may be reported separately.

The guidelines for E/M services can be found in the introductory notes to the Initial Hospital Care subsection in the Evaluation & Management section of the CPT manual and in the American Medical Association's (AMA) coding newsletter (CPT Assistant, Volume 8, Issue 3, March 1998).

POLICY EXCEPTIONS

None

POLICY GUIDELINES

POLICY HISTORY

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