Professional Charges in an Inpatient Setting and Best Practices for Coding Multiple Scenarios. Webinar Subscription Access Expires December 31.

Transcription

1 Professional Charges in an Inpatient Setting and Best Practices for Coding Multiple Scenarios Questions Answers Webinar Subscription Access Expires December 31. How long can I access the on demand version? You will find that in the same instructions box you utilized to access this presentation. Subscription access expires December 31, individual purchases will not expire for at least two years. If you are the purchaser, you can find your information through following these steps: 1. Go to & login 2. Go to Purchases/Items 3. Click on Webinars tab 4. Click on Details next to the webinar 5. Find the instructions box in the middle of the page. Click on the link to the item you need (Presentation, MP3 file, Certificate, Quiz) Where can I ask questions after the webinar? The online member forums, where over 100,000 AAPC members have access to help each other with all types of questions. *Forum Posting Instructions* 1.Login to your online account 2.In the middle of the page you will see discussion forums 3.Click on view all top right hand side 4.Select general discussion under medical coding unless you see a topic that suits you more 5.On the top left side of the forum box, you will see a blue button, new thread click on that 6.Type your question and submit 7.Check back in that location for answers as you please

2 If a patient is admitted to observation by one provider in the morning and discharged by a different provider that night, what codes should be used by each? if a patient is admitted and discharged on the same date of service and the admit is provided by hospitalist A and the discharge is provided by hospitalist B of the same group can you bill ? If so does it matter which provider you bill under? If from the same group, whoever saw the patient for the day would bill. If both sees patient on same day, within the group, they would need to decide who will bill for that day. This patient was not seen by a hospitalist, but typically both are from the same group, so they would need to decided between each other who would bill for the day. In order to bill the 99235, doesn't the patient have to be in at least 8 hours? For the short one-day observation stay what is required from the admitting physician - i.e., H&P with designation to Obs or admit orders, a separate Discharge Summary, and a separate record of patient assessment or progress note? Why do you bill a for the neurology consult instead a inpt consult code? That is the norm, but the physician order is the driver. When the order was issued, the intent was for observation pending neuro evaluation. Since the patient decided to leave AMA, the notes need to reflect this decision, but the order would not be changed based on patient decision to leave All 3 components must be documented adequately to meet the code level 99234, 99235, Any weak component drops the overall level to the level that all 3 are met This is a Medicare patient, Medicare no longer paying consultation codes

3 If patient is admitted for In patient chemo regime, but has an OVO vist and chemo as an Out patient on the day of admit. Can both providers bill the e/m on day of admit? Scnario 1 both admitting physician and the provider performing OVO e/m is from Hem/Onc. Scenario 2: Admitting physician is hopitalist and provider performing OVO is Hem/Onc provider The real answer is "it depends". If the patient is scheduled admit for chemo, the usual scenario is that the admitting physician would be HemOnc. If the patient is admitted by hospitalist for non-malignant reason, but is known CA patient, in need of chemo before discharge, Hem/Onc would likely be consulting on the case from the beginning. In that case, each physician would bill for their services So we can bill under either of the hospitalist and it is ok if the admit is documented by one physician and the discharge is documented by his partner? If from the same group, they must decide between each other who will bill for the day. Generally, a discharge, if different physician from admitting, would be from same group as admitting. Hospitals hold the admitting physician responsible for the general management of the patient during the admission. Findings from other specialties should be summarized by the attending physician at least in the discharge summary

4 how can you code malignant htn with only the verbiage accelerated? Is there any criteria listed somewhere in which a coder may make that determination based on the findings? The physician did document systolic reading greater than 180. Several things to note: 1) General hypertension (401.9), will not likely justify inpatient admission. 2) Hospital coders do hot have the physician available for query and must code based on inpatient coding guidelines, Coding Clinic clarification 3) Coding Manager and or Clinical Documentation Specialist knowledge of inpatient coding guidelines. With the statement of systolic reading greater than 180, the hospital coder would select unless patient also had heart &/or renal failure to justify combination codes 402.xx xx, 4) The coder can issue a query to the physician for additional clarification, but these are often not answered timely or not at all. Knowing the physician's reliability for answering queries may determine whether they will issue a query. Accelerated/malignant hypertension are hypertensive crises, and the physician did document accelerated hypertension are you saying that only one of them should see the patient? What if the attending Dr. went home before the patiient was discharged? If from the same group, whoever saw the patient for the day would bill. If both sees patient on same day, within the group, they would need to decide who will bill for that day.

5 if the hospital changes the stay to obs since they didn't meet their inpt criteria - what happens to all those that provided services - ie admitting phy, consults, etc - their claims would have been submitted as Inpt - can they legally change their POS to mirror that of the hospitals to ensure payment? On the physician bill - don't we need to assign the diagnosis that are being managed on each particular day? If a diagnosis is not managed today or is now resolved, would we also assign it? The hospital should notify the physician as soon as the determination is made so the change is made before billing. If the physician does not receive notification, the Utilization Review Manager should be notified. There will also be a physician serving on the UR committee, who could be notified if the information is not received. If the problem either must be managed by the physician or has bearing on the physician management, it is considered a codable condition unless it has been completely ruled out prior to discharge. This is followed by hospital inpatient coders. Why is the fall in case 2 be hospital acquired condition? Patient fell on her own accord. Why would the ortho not use the E code? Isn't reporting for the orthopedic specialist be claiming that code twice in same day? How would the ED physician claim the ER visit? The fall occured on the hospital property and must be evaluated for any hospital liability. They can report an E code. ED physician will bill for the Emergency codes. If the surgeon sees the patient for the first time in the ED, they may also report ED codes their POS will be 23 for that billing of emergency service. If surgery is 90 global, they are allowed 1 visit using modifier 57 Any physician is allowed to bill ED codes if that is the POS. Not restricted to those providers who staff the ED

6 FYI: I disagree with coding Case #2 for the Orthopedic Surgeion with DX because he will be managing her FX only...not her hypertension. I would only use the code if he documents that he is handling her HTN also. Thanks Is it approprite that the hospital instruct a private physician not to bill for services proviced because the patient did not meet inpatient criteria? will the documentation of the non billing hospitalist support the one that does bill? Are you saying that you can use both physicians documentation to bill a short stay code? Does the hypertension affect his management, of the patient? If no, do not need to code. If yes, could be coded Physician can bill, but needs clear communication with UR about any changes to patient status.l Often does appear to not happen. Hospitals are reviewed for appropriate inpatient admissions and may be denied payment if they admit without criteria being met. These matters can and should be discussed in hospital medical staff meetings. If both see the patient on the same day and they are from the same group, we typically review documentation from both to support the billing. We consider both if they are from the same group. If different groups, each physician's note must stand alone for documentation/coding purposes

7 When the hospital changes the status to obs since the criteria was not met and then the coder is informed by hosp personnel should the coder change the codes and POS to mirror what the hospital is submitting? Ideally, there will be communication between the hospital and attending physician about inpatient criteria. Hospitals typically use InterQual or Milliman criteria for Inpatient admission necessity. Often this communication does not appear to happen according to feedback that I receive, particularly from physicians. Hospitals are reviewed by certain agencies, QIO & Joint Commission, for example about suitable inpatient admissions. The hospital status and physician status should mirror. However, be mindful that hospital coding & billing is significantly different. Example, CPT is not reported on inpatient claims. If the hospital reports as an inpatient admission, the physician codes should also be from the inpatient hospital section. If the ED provider has already diagnosed and determined the need for surgery, why is the ortho provider's visit not considered a transfer of care and visit bundled into the surgery? ED physician will contact specialty on call for surgical admission. Whoever plans to do the surgery will usually have some discussion with patient and family prior to taking patient to surgery. It will be a transfer of care when the ortho issues the orders for admission & surgery. For 90 day global, the surgeon is allowed one E & M to be paid outside the global surgery, which would be the ED encounter to introduce themselves and advise the patient of surgery plans. This visit gets the 57 modifier