Forum - Questions & Answers

May 21st, 2009 - connie 1 

Prolonged care

Can prolonged care be charged in this situation in Illinois?

Hospitalists A does admission at 1am

Hospitalists B sees patient at 10am, meets with patient, reviews test results, discusses care with family

Can this be charged?
ex: 99223 Hosp A
99233 Hosp B
99356 Hosp B

OR:

99223 Hosp A gets both charges
99356

Can anyone tell me where I can see this answer in black and white so I can share with my providers
Thank you

May 21st, 2009 -

Here you go...

I don't think you'll get paid for an admission and a subsequent care in the same calendar date by doctors in the same group. (Are you sure the H&P did not start at 111:59 pm the previous calendar day?)

Hospital Visits Same Day But by Different Physicians
In a hospital inpatient situation involving one physician covering for another, if physician A sees the patient in the morning and physician B, who is covering for A, sees the same patient in the evening, Medicare Services will not pay physician B for the second visit. T he hospital visit descriptors include the phrase “per day” meaning care for the day. If the physicians are each responsible for a different aspect of the patient’s care, Medicare Services will pay both visits if the physicians are in different specialties and the visits are billed with different diagnoses.

So I think the first doctor should bill the H&P and prolonged services codes. Let's see what Betsy thinks

May 23rd, 2009 - Connie 1 

Prolonged care

The first Hospitalist's accepted the patient to his service at 11 pm but did not have a face to face visit with the patient until 2am and charged the admission for next day. The second Hospitalist's same day saw the patient at 10 am for review of labs, xrays and talked to family and he wants to bill a subs care plus prolonged care.

I think the admitting physician should bill admission and the prolonged care from the second physician unless diagnosis was different and then would concurrent care play a part, or if critical care took place then second physician could bill, I think. Greatly appreciate any suggestions.

May 23rd, 2009 - nmaguire   2,606 

Hospitalist

First of all, hospital codes are per/day. If the Hospitalist are same group would be all services by both physicians in the 24 hour day. Admitting physician would bill per day care/same group. Documentation by both would be used to arrive at the appropriate level of care. talking to the family does not constitute prolonged service unless it is needed to gather information when the patient is unable to provide, the physician would then formulate the plan of care. data order/reviewed is a part of Medical Decision Making.
Summary:
When multiple providers see the same patient on the same day, they need to combine their time and services for one overall E/M code. Because both physicians are billing with the same practice tax ID number, they would be considered one provider and their services would not be paid separately.
The suggested times attached to the initial visit codes (30 minutes for 99221, 50 minutes for 99222 and 70 minutes for 99223), The billing physician could potentially bill using a prolonged services code, but the time must be more than 30 minutes beyond the typical time spent on the history and physical to count toward the first hour of prolonged services.

Remember that physicians billing for prolonged services must document in the patient record the amount of time spent. Also keep in mind that most payers do not recognize non-face-to-face time spent.



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