Wiki Inpatient consults by two different orthopedic MDs for two different dx

[swallace1]

Patient admitted to inpatient hospital for multi-trauma, thoracic fracture and left elbow fracture. On call ortho MD - DR#1 performs consultation in ER. DR#2, spine specialist, from same practice, consults on patient the next day 6/3 and does surgery the same day to correct the thoracic fracture. On 6/6 DR#3 another physician from the same practice sees patient in consultation to address the left elbow fracture- non-operative for time being.
My question, how do I bill inpatient care for the 3 MDs involved? I think I should bill the consult and OP by spine specialist, but should the MD who consulted on the elbow fracture days later, be billed? What CPT code would I use? All 3 MDs have sent information to the billing office, requesting the practice to bill for the consults.
Any suggestions would be greatly appreciated.

 

[Pam Warren]

Different days? yes, you can bill all as consultations and/or initial/subsequent hospital visits, depending on the payer. The spine doc is a specialist, with a different taxonomy code, and as long as they are on different days you should be able to bill them all, particularly since the consultations were for different reasons.

 

[amyjph]

Agree, it depends on the payer as to what codes to use. However, these are all most certainly billable and you should bill them especially since they were on different days. Even if they were on the same day, depending on the payer they may be rolled up into a higher level or separately billed again, depending on the payer. It also matters who was the admitting provider. Usually it's not the ortho but the hospitalist, I have seen some cases where ortho actually admits but not as common.
You have to make sure your diagnoses are assigned correctly and don't mix between providers or attach all of them to all claims.
If the payer does not accept consult codes: If MD #1 saw the patient in the ED called in by the ED doc, you might be billing an ED EM. But, if the ortho admits the patient from that visit you may end up billing initial hospital care. Then, if the patient is admitted inpatient, it is possible MD #2 and MD #3 would both bill initial codes if they are performing an initial evaluation. They may end up with subsequent codes, though. It all depends on the timing, documentation, and who admitted. If the payer accepts consult codes, things will be different.
Then, once the spine doc MD #2 did surgery and the patient was in global for that, any rounding any provider does on that diagnosis/surgery in the global would be part of the global and not billable. The elbow care would be billable unless that goes into a global too. However, if there is rounding for other injuries not in a global, those would be billable subsequent. This is where modifier and diagnosis code attachment becomes very important especially with providers all in the same group. What happens a lot in these multi-trauma cases too, is they fix the most urgent stuff and if the patient is inpatient for a longer period, other problems can crop up so you may have multiple injuries that subsequent E/M can be captured on for rounding. You have to exclude anything in a global and decide if there is enough documentation to support.