8 hours ago · Physicians may report a subsequent hospital care CPT ® code for services that were reported as CPT ® consultation codes (99241 – 99255) prior to January 1, 2010, where the medical record appropriately demonstrates that the work and medical necessity requirements … >> Go To The Portal
For office and outpatient services, use new and established patient visit codes (99202—99215), depending on whether the patient is new or established to the physician, following the CPT rule for new and established patient visits. Use these codes for consultations for patients in observation as well, because observation is an outpatient service.
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For an inpatient service, use the initial hospital services codes (99221—99223). If the documentation doesn’t support the lowest level initial hospital care code, use a subsequent hospital care code (99231—99233). Don’t make the mistake of always using subsequent care codes, even if the patient is known to the physician.
For an inpatient service, use the initial hospital services codes (99221—99223). If the documentation doesn’t support the lowest level initial hospital care code, use a subsequent hospital care code (99231—99233).
Inpatient and/or observation consultations Coding becomes more complicated in the inpatient hospital setting, where health care providers are instructed to bill the initial hospital care codes (99221–99223). As a result, multiple billings of initial hospital visit codes could occur in a single day.
The hospital admission status of the patient, such as inpatient, observation, emergency, or outpatient Health care professionals examine such factors to determine the appropriate code to use for services provided and how the codes compare for reimbursement.
Outpatient consultations (99241—99245) and inpatient consultations (99251—99255) are still active CPT® codes, and depending on where you are in the country, are recognized by a payer two, or many payers.
According to CPT, the initial hospital care codes, 99221–99223, are for “the first hospital inpatient encounter with the patient by the admitting physician.” Initial inpatient encounters by other physicians should be reported with either subsequent hospital care codes (99231–99233) or initial inpatient consultation ...
Current Procedural Terminology (CPT) is a medical code set that is used to report medical, surgical, and diagnostic procedures and services to entities such as physicians, health insurance companies and accreditation organizations.
Consultation Services CPT® Code range 99241- 99255 The Current Procedural Terminology (CPT) code range for Consultation Services 99241-99255 is a medical code set maintained by the American Medical Association.
If a social worker or therapist asks for your clinical opinion, bill that encounter using one of the initial hospital care codes (99221-99223). If another physician has already performed a history and physical for the admission, use a subsequent care code (99231-99233).
Emergency department (ED) consultation: Patient is admitted For Medicare patients, if the patient is admitted to the hospital by the general surgeon, he or she should bill an initial hospital care code (99221–99223) and not an ED visit code.
The Current Procedural Terminology (CPT®) codes offer doctors and health care professionals a uniform language for coding medical services and procedures to streamline reporting, increase accuracy and efficiency.
Healthcare Common Procedure Coding System (HCPCS)The Healthcare Common Procedure Coding System (HCPCS) is used to report hospital outpatient procedures and physician services.
ICD procedure codes are used only on inpatient hospital claims to capture inpatient procedures. Entities that will use the updated ICD-10 codes include hospital and professional billing, registries, clinical and hospital departments, clinical decision support systems, and patient financial services.
The entire process of consultation should be documented in the patient's chart: the request for consultation or, in the hospital, an order for the consultation; all physical findings and test results; a clear evaluation and recommendation; the attending physician's evaluation of the consultation and his or her own ...
A consult is provided by a physician whose opinion or advice is requested by another physician about a specific clinical problem or issue. Consultations may also be requested by nurse practitioners or physician assistants.
Current procedural terminology (CPT) is a set of codes, descriptions, and guidelines intended to describe procedures and services performed by physicians and other health care providers. Each procedure or service is identified with a five-digit code.
An important factor for correct coding is to report the service based on the location/status at the time of admission and if the payor is Medicare or follows Medicare rules related to consultation services.
Coding for surgical services can be complicated because it involves numerous rules, guidelines, and exceptions that frequently change. An area of exceptional difficulty is the correct use of codes for evaluation and management (E/M) of patients who require hospitalization. Coding for E/M services has become even more complex due to ...
For Medicare patients, inpatient consultations are reported with the initial hospital visit codes (99221–99223) . Do not append modifier AI, which is only used by the admitting physician. If the surgeon is consulted on case involving a Medicare patient who is in observation status, the surgeon should report new patient (99201–99205) or established patient (99211–99215) office/outpatient codes. For non-Medicare patients, if the consultation is done after the patient is admitted to the hospital, consultation services may be reported with the inpatient consultation codes (99251–99255). Consultation services in observation status are reported with the outpatient consultation codes (99241–99245). (See Table 4 for the 2013 total initial hospital, inpatient and outpatient consultation facility and nonfacility RVUs.)
If a patient is admitted after an ED consultation and is not seen on the unit (in the intensive care unit, for example) on the date of admission, only report the outpatient consultation codes (99241–99245) . If the surgeon sees the patient on the hospital unit on the date of admission, report all E/M services related to the admission with the initial inpatient admission service code (99221–99223) or initial observation care code (99221–99223). Do not report both an outpatient consultation and inpatient admission (or observation care) for services on the same day related to the same inpatient stay. (See Table 2 for the 2013 total initial observation, hospital, same day observation and discharge, and outpatient consultation facility and nonfacility RVUs.)
However, only one initial visit per specialty can be paid per stay. Follow-up visits in the facility setting may continue to be billed as subsequent hospital care visits (99231–99233). The coding depends on the admission status of the patient when seen and whether the patient is classified as Medicare or non-Medicare.
ED consultation: Patient is not admitted. A patient presents to the ED; general surgery is consulted, but the patient is not admitted to the hospital. If the patient is a Medicare beneficiary, the general surgeon should bill the level of ED code (99281–99285).
Coding becomes more complicated in the inpatient hospital setting, where health care providers are instructed to bill the initial hospital care codes (99221–99223). As a result, multiple billings of initial hospital visit codes could occur in a single day. However, only one initial visit per specialty can be paid per stay. Follow-up visits in the facility setting may continue to be billed as subsequent hospital care visits (99231–99233). The coding depends on the admission status of the patient when seen and whether the patient is classified as Medicare or non-Medicare.
Service codes 99234 – 99236 are used to report observation or inpatient hospital care services provided to patients admitted and discharged on the same date of service. The codes should be reported in lieu of those described in Part I of this standard. All three (3) “key” components, history, examination and medical decision-making, must be included in the medical record documentation.
Initial Hospital Care may be reported only once per day by the same physician or physicians of the same specialty from the same group practice.
This modifier will identify the physician who oversees the patient’s care from all other physicians who may be furnishing specialty care.
The Hospital Discharge Day Management services (99238 or 99239) are not to be reported.
Hospital Discharge Day Management Services – E&M codes (99238, 99239) used to report the work performed to discharge a patient from an inpatient stay.
Only one hospital discharge day management service is payable per patient per hospital stay.
Initial hospital care – E&M codes (99221, 99222, 99223) used to report the first hospital inpatient encounter between the patient and admitting physician.
Instead, combine both levels of service in a subsequent visit code (99231-99233) based on the level of history, exam and medical decision-making.
To code visits after an inpatient surgery, use the subsequent visit codes (99231-99233), even for patients not covered by Medicare.
Inpatient consultations should be reported using the Initial Hospital Care code (99221-99223) for the initial evaluation, and a Subsequent Hospital Care code (99231-99233) for subsequent visits. In some cases, the service the physician provides may not meet the documentation requirements for the lowest level initial hospital visit (99221).
When a Medicare patient is admitted, and another physician provides a consultation for that patient, the situation may arise in which both the admitting physician and consulting physician would report an initial inpatient service (e.g., 99221-99223). To differentiate between the two physicians’ services, and to prevent a claims denial for duplication of services, the admitting physician should append modifier AI Principal physician of record to the initial inpatient service code.
For example: A patient presents to the emergency department with chest pain. The ED physician evaluates the patient and codes an ED visit (99281-99285). He also requests a consult from a cardiologist. The cardiologist evaluates the patient and decides to admit him. The admitting cardiologist would report an initial hospital visit (99221-99223) with modifier AI appended.
Consultation Coding for Medicare. Medicare does not accept claims for either outpatient (99241-99245) or inpatient (99251-99255) consultations, and instead requires that services be billed with the most appropriate (non-consultation) E/M code.
While CMS expects that the CPT code reported accurately reflects the service provided, CMS has instructed Medicare contractors to not find fault with providers who report a subsequent hospital care CPT code in cases where the medical record appropriately demonstrates that the work and medical necessity requirements are met for reporting a subsequent hospital care code (under the level selected), even though the reported code is for the provider’s first E/M service to the inpatient during the hospital stay.
The Centers for Medicare and Medicaid Services (CMS) is now focusing on how to reduce the amount of paperwork required of physicians in what is known as the “Patients over Paperwork” initiative. In the past, if a medical student performed and documented an evaluation and management service, the teaching physician was still required to personally perform and re-document his or her own evaluation.
And if a patient develops pneumonia in the hospital, the hospitalist would add that condition to the list of diagnoses he or she is managing, beginning on the date of service that the pneumonia was diagnosed.
We do interim billing every seven to 10 days. If a patient’s conditions change over the course of a hospital stay, the doctors keep updating the diagnoses. Can we simply keep the principal diagnosis as the condition that warranted the hospital stay at the time of admission along with the appropriate secondary codes for the entire stay?
But as of this year, teaching physicians may now verify in the medical record any medical student documentation of the components of an evaluation and management service. Attendings must still personally perform the physical exam and medical decision-making components that are being billed, but they may verify any medical student documentation in the medical record rather than re-documenting that work. The CMS will consider that verification requirement to be met if the teaching physician signs and dates the medical student’s entry in the medical record.
To your question, “Can we simply keep the principal diagnosis as the condition that warranted the hospital stay at the time of admission… ,” here’s my short answer: No.