Pulmonology Coding Alert

Question: My pulmonologist writes a short admit note with a problemfocused history of present illness, no review of systems, an expanded-problem focused exam with moderate medical decision making. I bill it 99223, but our auditor insists it lacks the proper documentation, and knocks it down to 99232. Am I missing something here?

Mississippi Subscriber

Answer: The minimum admission service requires the documentation of a detailed history, a detailed exam, and low complexity decision-making. When the physician does not document according to these minimum requirements, he must choose an option that is suitable to payer policy. Since the elimination of consultative services (99251-99255) and the resulting crosswalk of services from one category to another category (i.e., consults to initial hospital or subsequent hospital care, depending on the extent of documentation), most Medicare contractor's now allow the insufficiently documented admission service (99221-99223) to be reported with subsequent hospital care codes (99231-99233) reflecting the amount of documentation present in the record. If some payers still do not permit this type of crosswalk, the only other option is to report the service with the unlisted E/M code (99499).

Note: When reporting unlisted codes, you must manually enter a code description on the claim form (e.g., "problem-focused admission care") and a fee for the service.