Wiki Inpatient admission,not enough HPI bullets

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Coder2hear813

Coder2hear813

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Hospital Inpatient admissions have only detailed or comprehensive for history level.If there are not enough bullets in the HPI to qualify for an extended HPI, which you need to have for a detailed history. The scenario I have is a patient seen in the ER and then admitted. Would I use the lowest level 99221,even though this level requires a detailed history ? Any input or references is appreciated. Thank you:confused:
 
No you cannot default to the 99221 if you have not met the criteria. Was your physician the one that saw the patient in the ER prior to admission? If so then use the documentation for the ER visit as well as the admit note... If not then I would query the physician for more information, if the patient is not ill enough for the provider to get the information needed for the initial visit level then perhaps it should have been and observation stay.
 
Thank you

That's what I thought. I am only one point short of an extended so I am digging. The pt's cc is urinary hesitiancy, hesitancy would be considered AS/S or Quality ? I have been out of the e&m coding loop for quite sometime so please excuse my ignorance. Thank you
 
I was under the impression that ever since consult codes were eliminated by medicare it was feasible to use subsequent codes if not enough bullets were obtained to meet the critieria for initial codes. That being said could he have not used 99231 or 99232?
 
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Tonyj said:
I was under the impression that ever since consult codes were eliminated by medicare it was feasible to use subsequent codes if not enough bullets were obtained to meet the critieria for initial codes. That being said could he have not used 99231 or 99232?
Click to expand...

That applies to the consultant not to the admitting provider.
 
mitchellde said:
That applies to the consultant not to the admitting provider.
Click to expand...

Our local MAC (WPS) allows us to bill a subsequent inpatient code if the documentation does not meet the requirements for an initial visit. They do not specify that this is for "consultants" only.

"Question 7: I am the admitting physician for the patient and today is the first day I see the patient. However, my documentation does not support the level of service for a 99221. Should I bill an NOC code or code to a subsequent care code?
Answer: If your level of documentation does not support the procedure code 99211, CMS has instructed contractors to not find fault with a provider using a subsequent care procedure code. The use of the NOC 99499 should be very rare. "

However, I will say that this should be a uncommon practice, as the documentation should be there! I would be afraid to submit too many of these and raise a red flag.
 
Coder2hear said:
Hospital Inpatient admissions have only detailed or comprehensive for history level.If there are not enough bullets in the HPI to qualify for an extended HPI, which you need to have for a detailed history. The scenario I have is a patient seen in the ER and then admitted. Would I use the lowest level 99221,even though this level requires a detailed history ? Any input or references is appreciated. Thank you:confused:
Click to expand...

"In situations where the minimum key component work and/or medical necessity requirements for initial hospital care services are not met, subsequent hospital care CPT codes (99231 and 99232) could potentially meet requirements to be reported for an E/M service that could be described by CPT consultation code 99251 or 99252. Contractors shall expect changes to physician billing practices accordingly. Medicare contractors shall not find fault with providers who report a subsequent hospital care code (99231 and 99232) in cases where the medical record appropriately demonstrates that the work and medical necessity requirements are met for reporting a subsequent hospital care code (under the level selected), even though the reported code is for the provider's first E/M service to the inpatient during the hospital stay."

https://www.cms.gov/transmittals/downloads/R147BP.pdf

Palmetto GBA...

Jurisdiction 11 Part B
Can I submit a subsequent hospital CPT code if my documentation does not support one of the three levels of initial hospital services?

Answer:
Yes. Submit services that do not meet the minimal documentation requirements for the initial hospital service (CPT codes 99221-99223) as subsequent hospital visits (99231-99233). In all situations, submit the evaluation and management (E/M) code that represents where the visit occurred and that identifies the complexity of the visit performed.


last updated on 10/04/2011
 
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