Cardiology Coding Alert

Everything the cardiologist does can contribute to greater MDM When you find yourself assigning a code for subsequent hospital care, don't limit yourself to 99231. Otherwise, you may raise a payer's red flag and mark your cardiology practice for a future audit.
 
Physicians generally report 99231 (Subsequent hospital care, per day, for the evaluation and management of a patient ...) more often than any other subsequent hospital care code, according to CMS data. This means either most subsequent hospital visits are low-level services or doctors routinely undercode for inpatient care. As long as your documentation warrants it, you should feel free to report higher-level subsequent hospital care.
 
Because carriers usually bundle hospital care into postsurgical visits, many cardiologists aren't familiar with the documentation guidelines associated with subsequent hospital care for nonsurgical situations, such as myocardial infarction (MI) or congestive heart failure (CHF). If you pick up the patient's care after another physician - such as a general surgeon - admits the patient to the hospital, you should report from the 99231-99233 code range.
 
Use the following four tips to ensure you're properly assigning these codes: 1. Learn the Coding Levels You may believe that reviewing documentation is the first step to determine whether you can increase your inpatient coding levels, but that's actually the second step. If you don't know what constitutes each service level, reviewing the documentation won't help. So educate your practice regarding what CMS requires for each care level.
 
As a starting point for physician education, coding experts suggest these basic guidelines for the three subsequent hospital care levels:
  99231 - Patient is stable, recovering or improving.
  99232 - Patient is responding inadequately to therapy or has developed a minor complication.
  99233 - Patient is unstable or has developed a significant complication or a significant new problem. While the documentation (history, exam, complexity, and maybe time) will ultimately drive the supported service level, these guidelines help illustrate the differences in terms more familiar to cardiologists. Make sure they understand the importance of their documentation.
 
If your practice routinely reports 99231 for all subsequent hospital care services, tell your physicians that this might raise red flags with your payers, coding experts say. "Excessive reporting of 99231 would indicate that the practice is routinely downcoding, or the patients should have been discharged earlier," says Bob Lloyd, CEO of Mid-State Cardiology in Nashville, Tenn.
 
For example: A carrier may cite your practice for "poor quality of care" because you consistently report low-level codes. If you submit only 99231, the payer may interpret that as saying all hospital patients, regardless of their conditions, receive only a problem-focused history and exam. This can indicate to managed-care plans that your physicians never take a complete history [...]