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Charge CPT procedure codes to inpatients under certain conditions

APCs Weekly Monitor, November 7, 2008

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Q. My hospital has some existing charge procedures that bill to these codes for both inpatients and outpatients. Is charging CPT 99201–99203 and 99211–99213 to inpatients ever appropriate? From all I've read and heard, I believe their use for inpatients to be inappropriate.

A. CPT codes do not print on inpatient accounts, but if the clinical staff orders a service that is medically necessary, then renders it and documents it appropriately, charging for the service is appropriate.

For example, if a physician orders a certified wound nurse to assess a patient’s pressure ulcer, your best option may be to bill the assessment of that ulcer as a visit code on the inpatient account. The service would meet the criteria of being ordered, medically necessary, and documented. In this example, billing it to the inpatient account is appropriate if you:

• Have provided only an assessment and performed no procedure, and
• Would use a visit charge to report the same service on an outpatient account

The E/M level your facility assigns is based on the hospital’s E/M clinic tool to ensure reporting of the appropriate level of hospital resources.

The charge is added to the inpatient account and will be reflected under the assigned revenue code and total charge amount, but the CPT code will not show on the UB04.

CMS provided related guidance in Transmittal R321OTN. To view it on the CMS Web site, click here.

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