EM Coding Alert

Test and grade yourself to see if you need to take a refresher course.

Answer 1: CMS no longer recognizes consultation codes 99241-99245 (Office consultation for a new or established patient, …) and 99251-99255 (Inpatient consultation for a new or established patient, …), if the beneficiary is a Medicare patient. You will instead report the appropriate level from the 99221-99223 (Initial hospital care, per day, for the evaluation and management of a patient, …) code range.

You would use 99231-99233 (Subsequent hospital care, per day, for the evaluation and management of a patient ...) if the documentation does not fulfill the requirements for the lowest level of initial visit and the physician is seeing the patient in a consultative capacity.

Private payer alternative: “When the payer accepts the inpatient consultation codes, and the documentation supports a consultation service, the provider should select the appropriate code from 99251-99255 for inpatient consultation,” Kathleen Draskovish, CCS-P, CPC, B.S., managing consultant at Medical Revenue Solutions LLC in Oak Grove, Mo.

Answer 2: For some payers, the answer is yes. As of September 10, 2013, CMS says you can mix and match the following 1995 and 1997 ways of counting history of present illness (HPI) with the exam to choose the level of service:

• 1995: Count 1-3 elements for a brief HPI and four or more for an extended
• 1997: Count 1-3 elements for a brief HPI and four or more, or the status of at least three chronic or inactive conditions, for an extended HPI.

Meaning: You can pick which set of guidelines works best for the HPI, and still choose 1995 or 1997 guidelines for the exam portion of the encounter.

“We now can just count the bullets and not have to worry which set of guidelines we are using,” says Kevin Solinsky, CPC, CPC-I, CEDC, CEMC, president of Healthcare Coding Consultants, LLC in Gilbert, Ariz.

Remember: Contacting your payers to see if they will recognize this guidance is still a good idea.

Answer 3: A normal newborn does not have health issues. The exception is a newborn with mild jaundice. Because mild jaundice does not require phototherapy, you should consider newborns with mild jaundice normal and you can code from the 99460-99463 (…, for evaluation and management of normal newborn …) range.

If your doctor’s patient needed additional attention because of poor circulation, breathing, or physical condition, you would code from the initial hospital care codes 99221-99223 (Initial hospital care, per day, for the evaluation and management of a patient ...) at the appropriate level for the extra attention beyond birth.