We have a group of hospitalists (NPs) who perform medical evaluations (H&P) at an inpatient psychiatric facility. We are billing E/M codes 99221-99223 for the H&Ps and the psychiatrists are billing their psych codes. Our diagnoses are primarily medical. However, in a lot of cases the patient has no chronic illnesses therefore we have to use a mental health diagnosis. Both services are done on the same day. Is it appropriate for the hospitalists to bill 99221-99223? Or would it be more appropriate to bill a consult code? Please advise. If you can direct me to more information, that would be appreciated.
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Tag Archives: visits
New Benefit Enhancement for 2019 Care Management Home Visits
Effective Jan. 1, 2019, providers who are participating in Next Generation Accountable Care Organizations (NGACOs) are gaining a new covered benefit enhancement to offer their patients who are not otherwise covered by original fee-for-service (FFS) Medicare. Benefit enhancements are conditional waivers of certain Medicare payment requirements. For 2018, benefit enhancements include: Three-Day Skilled Nursing Facility Rule Waiver Post-Discharge Home Visits […]
AAPC Knowledge Center
Region 4 – Shared Visits
Advanced practice practitioners (APPs) may perform and bill for Evaluation and Management (E/M) encounters separately from a physician. The Medicare Claims Processing Manual further defines APPs as: nurse practitioner (NP), physician assistant (PA) clinical nurse specialist (CNS), or certified nurse midwife (CNM). For some encounters physicians may elect to split or share the encounter with […]
AAPC Knowledge Center
Level 5 Office Visits
I have a provider that is insisting he was instructed by the ASCO to code all chemotherapy patients a level 5. I find this hard to believe. (FYI…We are seeing the patients in the office setting and not the ones who are administering the chemo. We do write the chemo order. The patient is receiving it outpatient through the hospital). Everything in his note states the patient is stable and doing well. Has anyone else heard this? Many of these patients are seen every 1-2 weeks and I do not see how all these appointments could be a level 5. I have asked the provider for a link or copy of this information but have not received a reply back. Any information anyone has would be greatly appreciated. Thank you!
His actual reply is as follows:
All patients getting chemotherapy would be considered high complexity management. They would all be considered "Drug therapy requiring intensive monitoring for toxicity"
This was a subject that came up at ASCO recently and everyone was surprised about billing them at level 4.
Billing insurance for pre-op and post-op visits for a cash pay surgery
One of my providers posed this question.
A pt has a surgery done and must pay cash (for denial, elective surgery, etc.). Other specialists practices are telling us they are still billing the pt’s insurance for the pre-op and post-op visits. (Even those w/in the global period). He asked if it would be "correct" to bill this way.
I told my provider that I was uncomfortable doing this, because even though the pt paid cash, I feel it is still a global charge and I am also afraid that if we were audited we would get cited for not billing equally to all of our patients.
Thoughts?
Billing BCBS for extra prenatal visits for High Risk Patient
Does anyone know how to get paid by BCBS for prenatal visits that exceed the normal 13? High risk patient.
hospital observation vs ED visits
if pt is seen in ED to rule out labor and being sent home, do i bill e/m (99213, 99214) for doctor who evaluated pt? or is there a seperate E/M code for ED visit?
I understand that if patient goes straigt to meternaty ward for observation 99218 is to be used. but what if patient is beeing seen at ED only?
Z01.818 for E/M visits prior to chemo treatment
We are trying to get more information on using Z01.818 for office visits for patients prior to chemo treatments as they evaluate the effects of chemo on the patient and whether they can continue with their treatment on that day or not. Of course, if no treatment is given, this code cannot be used. These office visits are usually a level 3 or 4, sometimes a 5. We know that the chemo admin code has a low level inherent E/M included. One of the descriptions we found for Z01.818 is "an encounter for examination prior to antineoplastic chemotherapy".
Does anyone use this code? Are there issues with denials and/or certain payers? What is the criteria you use to use this dx?
Thank you.
Wiki subsequent orthopedic inpatient visits, i. 99231, 99232
I am an orthopedic coder needing some clarification. A patient is initially seen in the ED with a femoral neck fracture and the ED provider is requesting Ortho consultation; a hospitalist accepts them as an admit. The Ortho provider consults and determines that the patient needs to be taken to the OR for a hemi/total arthroplasty, he also reviews labs done and reports patients INR is too high to safely take patient to surgery. The Ortho provider see’s the patient for another 3 subsequent inpatient visits monitoring the patients INR and providing Vitamin K and managing this patient with another hospitalist/cardiologist in consultation as well. Can we bill those subsequent visits after the decision for surgery was made on his initial consultation? If the orthopedic provider was not providing any care regarding his INR except for coming in to the patients room and reviewing labs and the patient, would we be able to in that circumstance? We don’t do much inpatient visits in Orthopedics so I cant say Im definitively comfortable in this situation.
thanks for the help in advance
Two ER visits same day
Patient presented to ER with Epistaxis… CPT 99283-25 and CPT 30903-LT billed for first visit. Patient returned few hours later for same reason and second 99283 billed by same ER provider. The insurance is stating that the second visit paid in error since it is included in global days. From my research, CPT 30903 has no global period. Should the second 99283 also be billed with 25 modifier?
Thanks!