Wiki Initial hosp. Care e and m

[MATHEODO]

This is going to sound like a beginner question BUT here goes. What is already know.....If a patient as admitted as an inpatient, the admitting physician would bill 99221 thru 99223 depending on the key components....The lowest E & M for an inpatient admission is 99221 which is a detailed or comprehensive history, a detailed or comprehensive exam, and medical decision is strightforward or low..Being intital hospital care 3 out of 3 key components have to be met....My question is...what if the admitting physician does not meet all the key components for even the lowests Initial Hospital Care E & M...Like say the History was only expanded problem focused. The admitting physician does a expanded problem focused hsitory, a detailed exam, and straightforward medical decision making...they did not meet the criteria for a 99221...would they bill a subsequent 99231, instead of an initial, which they do meet??

 

[jdibble]

If your doctor is the admitting doctor then he cannot use the subsequent codes for an initial admit. The use of the subsequent codes are allowed to replace low level consults only. You could check with your carrier to see if they would allow the use of the subsequent codes, however you could use 99499 - Other E/M services.

 

[MATHEODO]

Thank You. I didn't think you would. I am going to get in contact with a textbook publisher that they need to verify their information.

 

[MATHEODO]

Billing subsequent visit on the initial visit

I did a little more research as it seemed so odd that an attending would bill with a subsequent visit for the first time seeing the patient in the facility. Per CMS, effective 01.01.10, they "If the documentation for the initial visit does not support one of the initial inpatient procedure codes, CMS has instructed contractors to not find fault with the physician billing a subsequent care procedure instead."

CMS is allowing this for both attending and consulting physicians as of 01.01.10.