General Surgery Coding Alert

Question: How should we report the following situation: Dr. Afrom our surgery group admits a patient to the hospital and bills this as a level-one hospital admission. Dr. B from our group follows up with the patient later the same day because the patient needs labs and an x-ray reviewed. How do both doctors get paid for their time?

Louisiana Subscriber

Answer: If Dr. A and Dr. B are part of the same general surgery practice and are billing under the same group number, the combination of their services is no different than if Dr. A provided both services. Most payers treat physicians billing under a single group number as a single entity.

When the two physicians are in separate practices and are not billing under the same group number, Dr. A would report 99221 (Initial hospital care, per day, for the E/M of a patient ...). Dr. B would bill the appropriate initial inpatient consultation code (99251-99255) under a different diagnosis to show medical necessity for his services, particularly if he performed the follow-up visit at the request of Dr. A. In addition, Dr. B would send a written report to Dr. A detailing why he was asked to see the patient, his opinion on the patient, and any recommended treatment. If, however, Dr. A did not request that Dr. B see the patient, Dr. B can bill the follow-up visit with the appropriate-level subsequent hospital care code (99231-99233). Both doctors can use the same diagnosis code.