33 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 are met for reporting a subsequent hospital care code (under the level selected), even though the … >> Go To The Portal
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).
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CPT is also used to code hospital services and procedures provided to outpatients destruction (lesion) A non-sharp removal of a skin lesion done by chemical, cold (cryosurgery), laser, electrosurgery, etc.
Don’t make the mistake of always using subsequent care codes, even if the patient is known to the physician. 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.
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.
Outpatient consult codes can be based on face-to-face time, if more than 50% is spent in counseling and/or coordination of care. Inpatient services can be based on unit time, if more than 50% of the visit is based on counseling and/or coordination of care.
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.)
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.
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.
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 ...
The severity of illness and appropriate documentation of elements of the history and physical to determine the level of service. The hospital admission status of the patient, such as inpatient, observation, emergency, or outpatient. The disposition of the patient after the evaluation. Whether the patient is covered by 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).
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.
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.
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.
Submit the H&P as an initial visit (99221-99223) on the day you see the patient under your name and number.