February 2007

Go Unlisted If Less than 99221 is Documented
E/M Tip of the Month
Are you certifiable for a Specialty Coding Professional credential?
Upcoming Events

Hello from the Board of Medical Specialty Coding! We hope you enjoy your monthly ezine and find the information useful. If you have any comments or recommendations for future issues, please contact me through the following channels:

Victoria Forlini, Executive Director
vforlini@medicalspecialtycoding.com
301/287-2250 (phone)
301/287-2941 (fax)

Go “unlisted” if less than 99221 is documented
Impress upon your doctors and coders that initial hospital visits not documented enough to qualify for code 99221 must default to unlisted E/M code 99499. Trying to code the service as a subsequent hospital visit violates correct coding principles.

Initial hospital care code 99221 will net you about $85 this year – but only when your physicians document at minimum a “detailed” history and exam, and medical decision-making (MDM) of “straightforward” complexity. What happens when the documentation falls short of those requirements? an attendee asked panelists at the American Medical Assoc. (AMA) CPT and RBRVS 2007 Annual Symposium Nov. 16-17 in Chicago. The replies:
“You could use the unlisted code,” says Peter Hollmann, MD, senior medical director at Blue Cross and Blue Shield of Rhode Island and a CPT Editorial Panel member. CPT guidelines say all three key components must be met for the initial hospital care codes, he points out, so you can’t use 99221 even if documentation for two of the three components qualifies.

“You guys are stuck because the doctor didn’t do it right,” adds Richard Whitten, MD, a practicing general internist and medical director for Medicare’s Part B carrier for Washington, Alaska and Hawaii. From a CPT point of view the unlisted code is OK. Medicare says a follow-up hospital visit code (99231-99233) isn’t appropriate, although some carriers may allow it, he also cautions.

The reason you should not default to a subsequent hospital visit code when documentation isn’t adequate? The intent of the service is initial care, and correct coding dictates that you stay within the category of codes that accurately defines the service – in this case, “initial hospital care” (see Coding Pro 11/06).

Also remember: 99221-99223 may only be assigned appropriately by the admitting physician or group, and they may be used only once per hospitalization. The first visit by any other physician who sees the patient while in the hospital must be coded as either an inpatient consultation (99251-99255) or subsequent hospital care (99231-99233) (see ICD-9/CPT Coding Pro 11/06).

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E/M Tip of the Month
Test your E/M coding skills by identifying the answer to this question:

May diagnostic or therapeutic services be performed in conjunction with a consultation?

Yes or No?

Find out the answer at the bottom of this email newsletter. Also check this space monthly for the E/M Tip of the month.

Are you "certifiable" for a Specialty Coding Professional credential?
Now you can get the SCP credential, which tests the coding skills and guideline knowledge of specialty coders with about two years experience. You can get the recognition you deserve within your specialty! We will begin offering our skills-based SCP in six specialties starting in February, with more specialties to come!

The SCP complements our already-established Advanced Coding Specialist (ACS) credential. If you have an exemplary knowledge of coding issues and use that knowledge to better communicate with physicians and less-experienced coders, the ACS may be for you.

What are the benefits to specialty credentialing?

* Show your mastery of coding skills through skills-based exams
* Improve your marketability and clout in your work environment
* Interact with more ease with physicians
* Personal satisfaction

Because of our new initiatives and expanding opportunities, we've changed our name! The Board of Advanced Medical Coding is now the Board of Medical Specialty Coding -- and stronger than ever!!

Learn more about the SCP credential on our website!

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Upcoming Events

Here's the 411 on some upcoming events where you'll get top-notch educational opportunities to earn CEUs and even a place to sit for your specialty certification or recertification exam!

Event: How the Right Modifier Will Help Unlock the Payment You Deserve
Date: February 22, 2007
To register or to learn more information: http://www.partbnews.com/conferences/A1165/home.html

Event: 2007 Physician Practice Forum
Date: February 26-27, 2007
To register or to learn more information: http://www.decisionhealth.com/conferences
/complianceforum/index.html

Event: How to Assess Whether Your Practice is Ready to Report Quality Measures to Medicare and Qualify for Bonus Payments
Date: February 27, 2007
To register or to learn more information: http://www.partbnews.com/conferences/A1173/home.html

Event: Billing and Coding Pain Management 2007
Date: April 18-20, 2007
To register or to learn more information: http://www.decisionhealth.com/conferences/pain2007/

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Answer to the E/M Tip of the Month is...

Yes. They may be initiatied at the initial consultation service or follow-up visits. Ongoing management following the initial consultation service must be reported using the subsequent care visit codes for the appropriate place of service. In the office setting, that would be established patient codes 99212-99215. In the hospital setting, use subsequent hospital care codes 99231-99233.
Source: http://www.cms.hhs.gov/MLNMattersArticles/
downloads/MM4215.pdf