Disqus - Latest Comments for happyhospitalist

Re: RVU E/M 2011, 2012 Work (wRVU) and Total (tRVU) List For Common Hospitalist CPT Codes

happyhospitalist — Fri, 13 Oct 2017 13:01:16 -0000

If the patient is observation or ASC status, it is considered outpatient. That means when billing for a consult in the hospital when the patient is ASC or observation status, you need to determine if the patient is an established patient or a new patient. See this link:

https://thehappyhospitalist...

For established patients you would bill CPT 99211-99215. For new patients you would use CPT code set 99201-99205. I hope that helps.

Re: 99291, 99292: How To Bill Critical Care E&M CPT® Codes 99291 and 99292

happyhospitalist — Fri, 01 Sep 2017 14:48:25 -0000

Is it possible that the hospital they are at has an agreement with the insurance company for bundled payments. There are lots of bundled payment models being used these days. Possibly fee-for-service doesn't apply in those situations. I would inquire with the hospital where they are being performed

Re: 99291, 99292: How To Bill Critical Care E&M CPT® Codes 99291 and 99292

happyhospitalist — Fri, 01 Sep 2017 09:52:51 -0000

A different provider in a different specialty should be able to provide consultative opinion on a day procedure is performed, including critical care I'm not certain if provider A can bill critical care on the same day they provided the procedure.

Re: http://thehappyhospitalist.blogspot.com/2008/05/come-forth-great-communicators-and.html

happyhospitalist — Sun, 20 Aug 2017 22:20:23 -0000

The link is embedded in the article with "CMS" Here is the direct link. Read the part in read writing at the link. 30.6.9.2 B

https://www.cms.gov/Regulat...

Re: 99291, 99292: How To Bill Critical Care E&M CPT® Codes 99291 and 99292

happyhospitalist — Thu, 17 Aug 2017 07:50:20 -0000

No action by the physician needs to be taken to presume critical care. For example, if a patient with septic shock is intubated and on pressors and the physician makes no change in vent settings or change in pressor rate, that is a decision too. A decision not to make any changes. You don't have to write a new order or change anything for a patient to be managed for critical care. The decision to keep things the same IS an action and doesn't make the patient any less critical in nature. So, again, it is helpful for the provider to write that the patient is critically ill, but if they don't, I would error on the side of the provider for their bedside judgement.

Re: 99291, 99292: How To Bill Critical Care E&M CPT® Codes 99291 and 99292

happyhospitalist — Tue, 15 Aug 2017 08:20:33 -0000

This is a great question. I think it comes down to documentation. I think physician judgement is important in clarifying the critical nature of the patient's illness. When billing critical care, whether in the ICU or not in the ICU setting, I try to support my documentation by clearly stating in my notes that the patient continues to experience critical illness, specifically to help coders and auditors understand how sick the patient is. I appreciate that nonmedical coders and nonmedical Medicare auditors may not always understand the critical nature of the patient, that can't always be captured by vital signs. Bed side determination of critical illness is important to understand whether to choose 99233 or 99291 for determining the correct code. I encourage practice coders out there to tell their MD, PA and APRNs to clearly write that the patient remains critically ill in their note. But if they don't, and the provider bills critical care, I think coders should error on the side of provider experience and allow their charge to stand.

Re: 99291, 99292: How To Bill Critical Care E&M CPT® Codes 99291 and 99292

happyhospitalist — Thu, 10 Aug 2017 17:23:38 -0000

http://thehappyhospitalist....

Re: 99291, 99292: How To Bill Critical Care E&M CPT® Codes 99291 and 99292

happyhospitalist — Thu, 10 Aug 2017 17:21:08 -0000

Regarding your first situation, the additional 35 minutes by physician #2 would not be a separate billable charge. Now, if physician #2 spent 40 minutes instead of 35 minutes, that would carry them into 75 minutes of critical care time when added to the 35 minutes of critical care time spent by physician #1 and physician #2 could bill a 99292. Remember, the threshold for billing a 99292 is 75 minutes.

Re: 99291, 99292: How To Bill Critical Care E&M CPT® Codes 99291 and 99292

happyhospitalist — Fri, 09 Jun 2017 21:15:40 -0000

Not sure what you Mean. Why would the transfer affect your MDM in the office?

Re: Can You Bill For Critical Care After The Patient Is Dead? Yes.

happyhospitalist — Sun, 04 Jun 2017 07:08:38 -0000

How do you bill critical care for technical components. They have their own CPT code.

Re: 99291, 99292: How To Bill Critical Care E&M CPT® Codes 99291 and 99292

happyhospitalist — Tue, 30 May 2017 16:31:48 -0000

Shared visits are not allowed for critical care. Meaning you cannot combine critical care time for a PA or APRN with an MD consign. Report either total physician time (and bill under MD or report total advance practitioner time (PA or APRN) and bill under their name.

Re: 99232 vs 99233 Coding Comparison (Subsequent Care Hospital Follow-Up).

happyhospitalist — Wed, 17 May 2017 17:40:16 -0000

I have not seen that as a requirement from the official Medicare guidelines . With that said, I think it's a good idea for that general principle to be followed, but I don't believe it is required.

https://www.cms.gov/Outreac...

Re: New and Established Patient Definitions (CMS vs. CPT®): The Definitive Resource

happyhospitalist — Wed, 10 May 2017 17:27:50 -0000

Medicare doesn't recognize consult codes anymore. I suppose if the doctor bills commercial insurance that does recognize consult codes they could use them

Re: Sorry: I'm Sick But Hope To Be Back Fully Soon

happyhospitalist — Tue, 10 Jan 2017 13:57:34 -0000

https://www.cdc.gov/flu/wee...

Re: Google: Penguin Recoveries Still Rolling Out But Should Be Done Very Soon

happyhospitalist — Fri, 07 Oct 2016 07:36:31 -0000

Sorry wrong animal. Did you ever recover from Panda?

Re: Google: Penguin Recoveries Still Rolling Out But Should Be Done Very Soon

happyhospitalist — Fri, 07 Oct 2016 07:26:05 -0000

Did seroundtableDOTcom recover?

Re: Observation CPT® Billing Codes 99234, 99235, 99236, 99217, 99220 Explained

happyhospitalist — Wed, 14 Sep 2016 17:44:44 -0000

Are you sure the ER is listed as the admitting physician. That's unusual. Why would the hospitalist be doing admission at 8 AM if they aren't admitting physician? Are you saying the ER physicians just doing admission orders? But is not the admitting physician of record? Also since the patient was admitted on a different calendar date and discharged on a different calendar day 99234-99236 wouldn't apply. Also look at question one at this link. http://www.wpsmedicare.com/...

It is exactly the scenario you are describing. Bill the admission observation code 99218 through 99220

Re: Observation CPT® Billing Codes 99234, 99235, 99236, 99217, 99220 Explained

happyhospitalist — Sun, 11 Sep 2016 08:08:23 -0000

Time starts when the physician sees the patient for residents. Per scenario 4 on page 7/14 on the link below: "The teaching physician’s bill must reflect the date of service he/she saw the
patient..."

https://www.cms.gov/Regulat...

There is something called a "primary care exception" and I don't have enough knowledge about this to make comment on billing in that situation.

I don't know the answer for when time begins for a NP shared visit note. I would assume the NP time DOES count since the note would be a shared visit (if it's on the same calendar date).

Re: Observation CPT® Billing Codes 99234, 99235, 99236, 99217, 99220 Explained

happyhospitalist — Sat, 10 Sep 2016 07:11:47 -0000

I stand corrected. Question 4 from this Medicare carrier response indicates that as long as the patient is in the hospital for more than 8 hours after the initial visit of the provider, then same day admit/discharge codes can be used. In this case in point both admit and discharge instructions were provided during the same initial encounter. I think the key here is that the patient was in the hospital for at least 8 hours after the initial visit by the admitting provider, whether or not a face-to-face encounter was provided for the discharge greater than 8 hours later. I have updated the post to reflect the change.

This is a great resource link below. Read question 4 in this case.

http://www.wpsmedicare.com/...

Re: 99291, 99292: How To Bill Critical Care E&M CPT® Codes 99291 and 99292

happyhospitalist — Fri, 02 Sep 2016 17:07:46 -0000

In other words I think you're both right but with your coders are saying is that your note after midnight needs to be separately identifiable in an audit situation

Re: 99291, 99292: How To Bill Critical Care E&M CPT® Codes 99291 and 99292

happyhospitalist — Fri, 02 Sep 2016 17:06:05 -0000

If the critical care starts before midnight and crosses the midnight hour bill your total time for before midnight even if the time crosses the midnight hour. You can start a new 99291 if there's an interruption in service after the midnight hour. Just bill separate note that is clearly identified as a separate note with a new date and a new time. Since all of the coding rules don't apply to critical care I don't think it really matters how is your note is written up just so that it can be identified as a separate an identifiable note on a new calendar date and meets the threshold time requirements for critical care 99291

Re: Will My Insurance Pay If I Leave Against Medical Advice (AMA)? Stop Spreading the Myth!

happyhospitalist — Sun, 21 Aug 2016 18:21:12 -0000

The threshold for most insurances the pay is medical necessity. Unless her policy has a specific rider that says coverage is canceled with leaving against medical advice which would be very unusual insurance generally pays for care up to the point of the decision for discharge either with or without the blessing of the physician

Re: Can a Hospital Force a Patient To Go To a Nursing Home (SNF)?

happyhospitalist — Fri, 12 Aug 2016 07:13:17 -0000

If your dad has an order by a qualified provider for home health care for medically necessary services that are covered, it would presumably be paid for

Re: Can a Hospital Force a Patient To Go To a Nursing Home (SNF)?

happyhospitalist — Thu, 11 Aug 2016 22:08:31 -0000

If the patient is a Medicare patient he or his POAcan file an appeal with Medicare to refuse discharge. Medicare has 24 hours to respond and agree with the discharge or not. Hospitals are required to inform you of this option

Re: Organic Vaccines Approved By FDA; To be Sold Exclusively at Trader Joe's.

happyhospitalist — Tue, 02 Aug 2016 16:15:02 -0000

So....apparently that one company that sells organic foods doesn't appreciate obvious organic satire!