Question: Which code(s) should I report if our endocrinologist visits a type I diabetic child in the hospital to treat the patient's uncontrolled glucose levels and also spends time teaching the patient and family about diabetes management?
California Subscriber
Answer: The codes you report will depend on whether the physician is treating an established patient or performing a consultation. Assuming that your physician treats an established patient, you should report subsequent hospital care codes (99231-99233) for the day's services. Base your level of service on the physician's documentation and the key components he indicates in the chart. The subsequent hospital care code that you report should account for the diabetes education your physician provides, as well as other treatment. If your endocrinologist performs a consultation, you should use inpatient consultation codes (99251-99255). Again, the level of service will depend on the physician's documentation.
Watch the time: If the physician's documentation does support the key components (history, exam and medical decision-making), but he documents more than 50 percent of his time counseling the patient on diabetes management, you should still use subsequent hospital care or inpatient consultation codes, but you should select the level of service based on the total recorded time of the visit (see our article "Learn the Coding Catch That Will Increase Your Level of Service" at right).
Prolonged service: If the time your physician spends exceeds the maximum allotted time for subsequent hospital care or inpatient consultation codes, you may also use the prolonged services codes (99354-99357). Use these add-on codes in addition to the hospital service code you report to account for the total duration of face-to-face time a physician spends providing extended services on a given date, even if the service is not continuous (see our article "Recoup $150 Extra per Visit for Extended E/M Services" in the March 2004 Endocrinology Coding Alert for more information). You will probably need to provide the carrier with documentation to prove that your physician did indeed provide services above and beyond the normal time allotment for the code you report.
