Severity of Conditions May Raise Inpatient Code Level

Tell your endocrinologist to document each condition's status separately
CMS data indicate that subsequent hospital care codes 99231 and 99232 (Subsequent hospital care, per day, for the evaluation and management of a patient ...) are among the top-10 codes that endocrinologists report each year. But if your endocrinologist automatically selects 99231 for every inpatient hospital visit he renders, he could be shortchanging your practice. Coders and physicians who know the levels of subsequent inpatient care (99231-99233) and the required documentation to justify each level can choose the most accurate code every time.
Most subsequent hospital care endocrinology patients have serious diabetes and diabetic complications, says Lawrence A. Domont, MD, FACE, a clinical endocrinologist with Advocate Medical Group in Park Ridge, Ill. And, inpatients may have thyroid cancer or thyroid disease, pituitary tumors, or other endocrine disorders, he says. While the mid-level of service, 99232, is probably most common, the nature and severity of the patient's condition(s) will determine which level of service the physician renders, he adds.
Consider Number and Severity of Condition(s)
Don't forget: You must consider the history, exam and complexity of medical decision-making when you select a level of subsequent hospital care, says Curtis J. Udell, CPAR, CPC, CMPA, senior advisor with Health Care Advisors Inc. in Annandale, Va. But it's also important to understand the nature of the patient's problems and status, he says. In addition to his usual documentation, the physician should individually list the conditions he is treating and clearly note the status of each.
Assess severity: You can generally assess the patient's status and condition severity as follows, Udell says:


99231 -- The patient is stable, improving or recovering; the prescribed treatment plan is working.

99232 -- The patient is responding inadequately to treatment, with possible onset of minor complications; small changes in plan of care should suffice to stabilize condition(s).

99233 -- The patient is unstable and not responding at all to treatment as expected, with possible onset of significant new problems or complications; condition(s) may be progressing in severity.

Count conditions: The number of diagnoses the physician treats also influences the level of care. The number of treated conditions per level of service may break down like this, Udell says:


One stable problem: 99231

Two stable problems: 99231 or 99232, depending on severity

Three stable problems: 99232

Four stable problems: 99232 or 99233, depending on severity

One stable problem and one acute problem: 99232 or 99233, depending on severity.

Real-life coding example: Your physician admits a patient with type II, uncontrolled diabetes who has renal complications [...]

- Published on 2004-06-21