coordination of care

Hello,

I have a question regarding a provider who billed a 99232. His chart note clearly reflects test results and his recommendation on the plan of care for the pt. There was no CC, HPI or exam, in fact going by the chart note it would appear that the pt was not even seen by this provider for the DOS billed. Can he bill a 99232? CPT definition states; physicians typically spend 25 minutes at the bedside and on the patient's hospital floor or unit. Because of the word "and" not "or" leads me to believe that to qualify for coding based on time for coordination of care the provider would have to see the pt as well as spending time on the floor/unit. Please clarify.

Thanks,
JB*

Interesting argument

But...if he is not seeing the patient for counseling, then he must be spending the time coordinating the care. So I would expect an auditor would want evidence of that- spoke to oncologist, reviewed scan with radiologist, etc. Developing a plan of care by looking at results and typing a note is not coordination of care.

So...

If he mentioned in his note that he spoke to another doctor and also wrote his recommendation, this would qualify for coordination of care? even without seeing the pt?


JB*

let's wait to see what Editor says

but I can tell you I have never seen two doctors talking together for 25 minutes and if they did talk that long it was to trade stock tips, not to talk about a patient.

99232 based on time, no CC, HPI or exam

Subsequent hospital visits are my least favorite notes. You can't read them, can't tell what doctor provided the service and they often lack history.

Having said that, you can use time to select the code for a subsequent hospital visit if the total unit time was 25 minutes, and over 50% was spent in face-to-face discussion with the patient. Coordinating care can be in the other 12.5 minutes.

All visits require a reason for the visit and relevant history. Often, subsequent hospital visits don't have either. The Documentation Guidelines don't make an exception for these types of services. Personally, I accept a lower level of "reason for visit" and "chief complaint" because of the nature of the visit. I could be wrong on this. But, the note needs some subjective data: No pain, no complaints, no SOB, Day 5 post op for XYZ. If there is no subjective data whatsoever, it is not a billable service, unless time is used. "I spent XX minutes, over half of which was in discussion with the patient about ABC."

My least favorite notes too...

Here is the dilemma; since the provider did not see the pt but spent time on the unit/floor coordinating care can you bill for this service? Or do they also need to see the pt along with coordination of care for it to be billable?

Thanks,
JB