Wiki Teaching Physician Confusion

[bedforak1]

Senario: an attending is billing an admission code and the resident dictates the H&P, but the attending does not review and confirm. Another resident dictates a progress note on the same day as the admission and the attending reviews and confirms that note, but it's only enough to support a subsequent care code. The provider bills an admission.

Do you give credit for the subsequent care code even if he billed the admit code with the GC modifier?

 

[LYDIA123]

If it doesn't meet an the lowest level admission, then you can resubmit with 99499 unlisted with medical notes. It would of met a subsequent hospital visit if it was for a consult.

 

[OCD_coder]

Check with the carrier and see if they will allow a subsequent visit CPT code when the documentation does not meet the Inpatient Admit. Novitas allows a subsequent code if the documentation does not meet the Admit CPT codes. Otherwise, I agree the 99499 CPT code would be the correct code.

You can only count the information the provider was present for and submits their own portion of the service, in this case it appears to be the second encounter, not the work of the H&P.

 

[Tonyj]

Check with the carrier and see if they will allow a subsequent visit CPT code when the documentation does not meet the Inpatient Admit. Novitas allows a subsequent code if the documentation does not meet the Admit CPT codes. Otherwise, I agree the 99499 CPT code would be the correct code.

You can only count the information the provider was present for and submits their own portion of the service, in this case it appears to be the second encounter, not the work of the H&P.

To my knowledge Novitas will not allow a subsequent visit code to be substituted for an admit. This only applies to consultations. If the admit note does not make level you'll need to query the physician.

 

[tammymwilson]

I have another scenario..... I know the answer.... I just need validation.

Dr. Resident sees a patient in follow up yesterday (8/5/2014). Dr. Attending sees the patient today (8/6/2014) and gives an appropriate statement with the date of TODAY, referencing Dr. Residents note (which was done yesterday). Would you bill this?

Tammy