If I Go See the Same Doctor Again Do I Get Charged for Cpt 99203

MY SEPTEMBER 2022 Cavalcade , "The ins and outs of observation billing," prompted some more than questions on how to bill for ascertainment services. In this month'due south cavalcade, we'll review two additional queries about observation billing.

Observation codes
Which codes should we utilise for a patient placed in observation by the night hospitalist at xi p.m., then discharged at 8 a.m. the side by side morning?

That's simple: If a patient is placed in observation on one calendar engagement and discharged on some other, report an initial observation care code (99218–99220) for the start day, and then the observation discharge code (99217) on the calendar engagement of the discharge.

Only the physician attending in observation tin can bill observation codes.

If, even so, the night hospitalist had placed that same patient in ascertainment on the aforementioned calendar day that the patient is discharged, you should use one of the codes for same day admission and discharge: 99234– 99236.

Observation consult
I exercise coding for a multispecialty practise that employs both hospitalists and specialists. When a patient is placed in observation and a specialist consult is called, what lawmaking set exercise I use to neb the consult: 99201-99205 (new patient office visit) or 99212-99215 (established patient office visit)? I'm under the impression that new patient guidelines do not pertain to observation. But I accept had only one claim denied when I billed a 99203—and I believe that denial was due to the fact that I also billed a 99236 (same 24-hour interval access and belch).

When a specialist is called in to see a patient in ascertainment, that service should be billed using the new patient E/G codes (99201-99205), as long as that patient has not been seen by anyone in that specialist's group and of the same specialty within the final three years.

Doctors have the aforementioned documentation requirements for a 99203 billed for an observation patient equally they would in an office or hospital outpatient dispensary. And call up: Merely the md attending in observation can neb the codes in the observation section of the CPT manual.

Inpatient admissions
Our night hospitalists admit patients between 5 p.m. and eight a.chiliad. Typically, they see (and neb for) patients who go far before midnight. But when they practise admit someone subsequently midnight, they bill an initial visit (99221-99223). The day hospitalist and then sees that patient later that same morning time. But when that mean solar day visit is on the same calendar day as the admission, we're not sure what to charge for it.

As you know, Medicare considers physicians from the same group practice and the same specialty every bit a single md. If a patient is admitted subsequently midnight and seen later that same day by a second hospitalist, the medical necessity of that 2d visit could be called into question. If y'all routinely have hospitalists who work days rounding on these patients, recall near how you desire to handle this scenario.

Both initial and subsequent visits are paid on a per-diem basis. When physicians from the same group and specialty bill two services on the same date, it will be viewed as a single visit. Y'all can combine the documentation of both hospitalists, then select the appropriate level of service for that visit—but only if both visits are medically necessary. That's a very important caveat.

Brand sure the physicians clearly reflect medical necessity in their documentation. You'll find more almost this scenario in the Medicare Claims Processing Manual, 100-four, chapter 12, section xxx.half-dozen.nine, subsection B.

Attestation dates
Does the date of an attending'south testament need to exist the same as the engagement the resident saw the patient? Or if the attestation appointment is different than that of the resident'southward service, does the attestation take to specifically state the date on which the teaching doc saw the patient? I'm billing for a service provided by a resident, merely the attestation is dated two days later and it is unclear when the attention physician really saw the patient.

If the supervising dr. is not physically present for the central or critical components of the resident's come across with the patient, the supervising md must independently see the patient, perform those elements and document the findings. This information is documented in the Medicare Claims Processing Transmission, chapter 12, department 100.

If the educational activity medico is physically present for those key or disquisitional components, the teaching dr. must still personally document his or her presence and attest to like-minded with the resident's evaluations and program of care.

The situation yous depict—a note generated by the teaching doctor that's dated days after the actual come across the resident documented—could be risky. It certainly does call into question whether the education doc was physically present during the visit. I recommend that you check with your legal department most how to study a service when there is a discrepancy between the date of service the resident provides and the engagement listed on the attestation statement signed by the supervising physician.

Sue A. Lewis, RN, CPC, PCS, has more than twoscore years of health care experience.

Published in the January 2022 issue of Today'south Hospitalist

hernandezfifue1988.blogspot.com

Source: https://www.todayshospitalist.com/billing-observation-initial-care-consults/

Share this post