General Surgery Coding Alert

When a surgeon works concurrently with other physicians to treat a patient, you'll stand a better chance of receiving full pay for the surgeon's services if the claim establishes that the care he or she provided was necessary because of special training or expertise in his or her specialty. Trauma surgeons in particular will likely encounter concurrent care situations. If, for instance, a trauma surgeon is providing overall coordination of care for a patient with a closed head injury, the surgeon will likely work with a neurosurgeon or neurologist to provide services for the patient, coding experts say. Likewise, a trauma surgeon may work concurrently with an orthopedic surgeon to provide care for a trauma patient with bone or joint injuries.

To support medical necessity for the surgeon's particular services and to further distinguish his care from that of the other physicians, you should ensure that the diagnosis codes are as precise as possible and linked directly to the services the surgeon performed. Remember that the more precise the diagnosis code, the more likely you'll be to show the medical necessity of the care delivered.

When the trauma surgeon continues to see a patient whose serious injuries are being treated by other physicians and no other diagnoses are available, the trauma surgeon should code as many injuries as possible to emphasize the coordinating aspects of his participation. Understand 'Concurrent Care' Definitions Knowing what payers mean by "concurrent care" is crucial to securing reimbursement. The Medicare Carriers Manual, Section 2020, defines concurrent care as occurring when more than one provider at a time provides services more extensive than a consultation. Thus, when more than one provider performs follow-up hospital care (E/M services) on the same day to the same Medicare patient, they would technically meet this definition of concurrent care, says Jim Collins, CHCC, CPC, president of Compliant MD Inc. and compliance manager for several cardiology groups around the country. Collins stresses that Medicare requires the following criteria for concurrent care services: both providers must be actively participating in treatment
the patient's condition must warrant the services of both providers
the services must meet Medicare's definition of "reasonable and necessary." According to Medicare, reasonable and necessary services are "considered under accepted standards of medical practice to be a specific and effective treatment of the patient's condition." If two physicians treating the same patient meet all three conditions, carriers will typically pay both claims if each physician reports a unique diagnosis on the claim, Collins says. "Reporting a unique diagnosis code that no other provider is using is the cleanest and most efficient way to obtain reimbursement for concurrent care."

Collins stresses, however, that this is easier said than done because [...]