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March 2007
Tip: When you bill an inpatient consult, make sure the physician ensures the request for an opinion is documented in the patient’s chart and, whenever possible, brings that information back to the office. Alternatively, be proactive and set up arrangement with the hospital to allow your coding staff to look at the records on a regular basis. Consultations performed in an inpatient setting are more vulnerable because the request for the consult generally is in the patient’s shared medical record, which is in the hospital and, therefore, difficult to access by the physician’s billing staff. “There’s no way to review the chart of every inpatient a surgeon treats,” says coding consultant Jan Rasmussen, Professional Coding Solutions, Holcombe, Wis. “In an ideal world, we’d have access to a patient’s chart, but in reality, most practices rely on the surgeon to bring back that information.” For example, when an inpatient is having feeding problems, the treating physician may call on a surgeon to examine the patient and possibly place a PEG tube. Or he may simply request that the surgeon place the PEG tube. “In the first case, you can bill a consult. But in the second you can’t, because there isn’t a request for an opinion in the patient’s chart,” Rasmussen says. Still, to the coder, the encounters may seem almost identical unless the surgeon ensures thereactually was a request for an opinion in the patient’s shared chart and gets that information back to the coder. Part of the problem, notes Rasmussen, is that physicians use the term “consult” loosely when referring patients. “After surgery, a general surgeon may request a ‘consult’ from an internal medicine physician, when what the surgeon really wants is for the IM physician to manage the patient,” Rasmussen says. “A look at the records would show that the surgeon wasn’t asking for an opinion, but wanted to transfer care of the patient to the IM.” Note: In a multi-specialty practice, medical records also are shared, but the patient’s shared medical record is on the premises, making it easier to confirm that a request for an opinion is documented. Medicare allows large group practices to include the consultant’s report in the medical record documentation and not require a separate letter from the consulting physician or qualified NPP to the requesting physician or qualified NPP. The written request and the consultation evaluation, findings and recommendations must be noted in the report from the consultant to the requesting physician. Resources: E/M Tip of the Month How often may inpatient consultation codes be used? Find out the answer at the bottom of this email newsletter. Also check this space monthly for the E/M Tip of the month. Take Your ACS or SCP Exam Online To make test-taking easier for you, you can now take the ACS and SCP certifications and ACS recertification exams online. It's simple! Register as you normally would -- via our website or on paper, and select the Online option. We will send you an email confirming your registration and giving you further instructions. Don't worry! You still can take the exam at a conference, but we're listening to you as you search for easier ways to become certified. Visit us at www.medicalspecialtycoding.com for more information. Are you "certifiable" for a Specialty Coding Professional credential? 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. Learn more about the SCP credential on our website! (Return to Top) Event: Ultrasound Coding: Master the Coding, Documentation and Billing Maze Event: ABCs of 99211-99215: How to Make Sure You Code at the Right E/M Level Event: The 29 and 59 Modifiers: Clearing Up the Confusion Event: Billing and Coding Pain Management 2007 Event: Anesthesia Billing, Coding and Compliance Event: Advanced Orthopedic Symposium Answer to the E/M Tip of the Month is... Once. The preface to inpatient consultation codes (99251-99255) in CPT 2007 says you can bill only one consultation per admission. The word “initial” has been removed from the inpatient consultation codes. Subsequent visits to the patient for the same problem should be billed with subsequent hospital care codes or, if the patient is in a nursing facility, subsequent nursing care codes (99307-99310). Source: http://www.cms.hhs.gov/MLNMattersArticles/ |
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