Practice Management Alert

Why you'll report these codes a little differently than other E/Ms

When your physician provides subsequent hospital care to a patient, the onus is on you to choose the proper level of evaluation and management service based on the physician's notes.

But how can you decide which level of E/M service to choose? And how can you be sure your subsequent hospital care claims include the proper documentation? Experts say these are the two vital components of a successful claim.

Answer: Billers often under-report subsequent hospital care services, resulting in a lower payout and hurting the facility's overall finances. This could occur if a biller doesn't realize that she does not need to satisfy all three of the E/M components to report the subsequent care codes, says Catherine Brink, CMM, CPC, president of Healthcare Resource Management of Spring Lake, N.J.

Another issue: You could also overcode subsequent care service if you fail to include documentation to back up your code choice. Overcoding subsequent hospital care visits could lead to denials and suspicious payers.

But don't just assume that subsequent hospital care coding is -mission impossible.- If you pay attention to the rules for billing these codes and observe the documentation guidelines, you can ethically max out your revenue for subsequent hospital care services.
 
2 out of 3 Ain't Bad for These E/M Codes When you are choosing a level of service for these encounters, you-ll decide among three codes:

- 99231--Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: a problem-focused interval history; a problem-focused examination; medical decision-making that is straightforward or of low complexity

- 99232--... an expanded problem-focused interval history; an expanded problem-focused examination; medical decision-making of moderate complexity

- 99233--... detailed interval history; a detailed examination; and medical decision-making of high complexity. But be careful when selecting a code from this family because to claim 99231-99233, the physician only has to meet two of the three key E/M components, says Mary Falbo, MBA, CPC, president of Millennium Healthcare Consulting Inc. in Lansdale, Pa.

Example: The physician provides subsequent hospital care to a patient. The notes indicate that he performed an expanded problem-focused interval history with a problem-focused examination. MDM was of moderate complexity.

-You only need to have two out of three elements, so if the notes indicate a level-one exam, but indicate interval history is expanded problem-focused and MDM is of moderate complexity, then that's all you need,- Brink says.

On the claim, report 99232 for the service.

Another major hurdle when coding subsequent care claims is that everyone interprets the definitions for each level differently. -The problems that we run into with [coding] scenarios, including the clinical examples provided by the AMA in CPT 2006, [...]