Forum - Questions & Answers

Jan 23rd, 2010 - johnhurwitz 3 

initial visits

Hello,
I'm a hospitalist that individually contracts with the hospital within a group of hospitalists that each do the same, i.e. we're not in the same "group". When I come on service I pick up patients from a doctor going off service. All these patients are new to me. They are obviously time consuming on the first visit. Can I bill initial visit codes (99221-99223) for these first day encounters?

Thank you,

Jan 23rd, 2010 -

Nope

You are assuming care from a like specialty so your visits are subsequent visits, but you certainly can use time as a factor to get a higher level visit but be sure your note documents the time spent. For hospital care it is face to face plus interactions with nursing, radiology, chart review, families, etc.

Jan 23rd, 2010 - johnhurwitz 3 

initial visits

Thanks. No initial visit. Okay. Regarding prolonged services, my understanding is medicare won't reimburse for non face to face care. The AMA's floor/ unit time definition of "face to face" care is specifically refuted by medicare.

Jan 23rd, 2010 - nmaguire   2,606 

Prolonged services

Prolonged service codes require prolonged services beyond the level of E/M rendered. It allows face-face and unit time with nurses or review of tests. It does not include talks with the family unless those talks are necessary to formulate a treatment plan because the patient is unable to do so.

Jan 23rd, 2010 - nmaguire   2,606 

no staff, no chart review

Here is med-learn article that expresses what can and cannot be included in prolonged service codes. http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5972.pdf

Jan 24th, 2010 - nmaguire   2,606 

Conflict in payers interpretation summary

A major change happened in the 2009 CPT book. The AMA used to define prolonged service codes as only face-to-face time beyond the threshold time defined in the CPT codes. With the 2009 CPT book the physician can now count any time spent on the patient care, including all unit/floor time spent.
However, CMS has not yet changed their rules. They still claim that prolonged service codes must be face-to-face.



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