A provider admits a patient to the hospital for five days and sees her each day. Which subcategory of E/M codes would be used for days two, three, and four?

A provider admits a patient to the hospital for five days and sees her each day. Which subcategory of E/M codes would be used for days two, three, and four?

• A. Office or Other Outpatient Services; Established patient
• B. Subsequent Nursing Facility Care
• C. Initial Hospital Care
• D. Subsequent Hospital Care

Answer: (D)

The situation tests how inpatient E/M encounters are coded by phase. When a patient is admitted to the hospital, the first day of the stay is billed as initial hospital care. From there, the physician provides ongoing daily management during the hospital stay, which is coded as subsequent hospital care. Since days two, three, and four are after the admission day and involve daily inpatient care, they fall under the subsequent hospital care subcategory. The level of service (and the exact code within that subcategory) depends on documentation of complexity, time, and medical decision making. The other options describe care settings that don’t apply to an inpatient stay (outpatient office visits or nursing facility care).

The situation tests how inpatient E/M encounters are coded by phase. When a patient is admitted to the hospital, the first day of the stay is billed as initial hospital care. From there, the physician provides ongoing daily management during the hospital stay, which is coded as subsequent hospital care. Since days two, three, and four are after the admission day and involve daily inpatient care, they fall under the subsequent hospital care subcategory. The level of service (and the exact code within that subcategory) depends on documentation of complexity, time, and medical decision making. The other options describe care settings that don’t apply to an inpatient stay (outpatient office visits or nursing facility care).