From the Research
The appropriate code for inpatient follow-up billing in a primary care setting is typically a CPT code from the 99211-99215 range, based on the complexity of the visit, as the most recent and relevant evidence does not specifically support the use of 99024-99026 for general inpatient follow-up care after discharge 1. When billing these follow-up visits, it's essential to document the connection to the previous hospitalization and any ongoing management of conditions that required inpatient care. The documentation should include the patient's current status, any changes to the treatment plan, medication reconciliation, and ongoing care needs.
- Key considerations for billing inpatient follow-up visits include:
- Using the appropriate office visit codes (99211-99215) based on the complexity of the visit
- Including the POS (Place of Service) code 11 for office setting
- Documenting the medical necessity for the follow-up visit and the complexity of decision-making involved in the patient's continued care after hospitalization
- Being aware that many follow-up visits within a certain timeframe (often 90 days) after a procedure may be bundled into the global surgical package and not separately billable
- The most recent study 1 highlights the importance of understanding billing reforms and their impact on collaboration between physicians and advanced practice providers, but does not provide specific guidance on coding for inpatient follow-up visits.
- In contrast, an older study 2 provides guidance on coding for hospital admissions and the importance of understanding the "fine print" in the Current Procedural Terminology (CPT) book code description, but its relevance to current billing practices is limited.
- Other studies 3, 4, 5 provide general information on coding and billing, but do not specifically address the question of inpatient follow-up billing in a primary care setting.