The physicians chief complaint is not supporting why the patient is in the hospital, it is supporting the reason it is medically necessary for that physician to see the patient that day.
Just because a patient is sick enough to require inpatient treatment and a physician sees that patient does not make that visit medically necessary.
It is somewhat common in fact for physicians to see patients for no other reason than the fact that they are patients of the physician and they are in the hospital. Or the patient is being discharged to say a nursing home but they don't have a room so the patient is stuck in the hospital a few extra days after discharge. These visit are of a social nature and are not billable.
If a patient is in house for say a hip replacement, ortho is managing the patient. They are also diabetic and have hypertension, both controlled. Ortho calls in the primary care since they have these other issues. PCP sees patient says all is good carry on. This visit is billable. Patient is in the hospital for say 2weeks, nothing going on with the DM or HTN, primary stops by every day, says patient is doing well and procedes to list all the reasons the patient is in the hospital in their assessment. Where is the medical necessity for these visits?
I have also found that sometimes hospital policy dictates who sees the patient and when, this is fine but you need to realize that hospital policy may not coincide with medical necessity as defined by those who are paying the bills.
Laura, CPC, CPMA, CEMC