Subsequent hospital visits

December 29th, 2015 - Codapedia Editor
Categories:   Coding   Evaluation & Management (E/M)  

Hospital services are all defined by CPT® as per day codes, that is, all of the care provided to a hospitalized patient during the calendar day.  If a physician (or that physician's covering partner of the same specialty) sees the patient a second time during the calendar day, a second visit is not submitted.  (See the articles on critical care and prolonged services for a description of when those services are reportable.)

The subsequent hospital visits (99231--99233) are defined by the level of history, exam and medical decision making that is performed and documented.  Time may be used as the determining factor in selecting the code when more than 50% of the total unit time that day is spent in discussion with the patient and family about the patient's diagnosis, risks and benefits of treatment, diagnostic tests, importance of compliance, etc.  50% of the unit time must be spent in this face-to-face service.

If a patient is seen for a second visit, the physician may combine the documentation from the two services and select the code based on both notes.  If the physician's partner performs the second visit, use the same rule: combine the documentation from both visits to select the level of service.  This is because Medicare and other third party insurance companies pay for physicians in a group of the same specialty as if they were one physician.  (See the Codapedia article on paying physicians in a group.)

If basing the code selection on time, remember to document time in the medical record.  If seeing the patient for a second visit, and basing the visit on time, document time for both visits.  Add the time for the day.  The typical times, listed in the CPT® book, are 15 minutes for the first level, 25 minutes for the second and 35 minutes for the third.

Physicians of different specialties using different diagnosis codes may both bill and be paid for visits to the patient on the same day.  If the same diagnosis is used, the claim may initially deny, and the physician office may need to send the notes for the day to prove that both visits were medically necessary.

If the visit is not legible, the payer will deny it as an unpayable service.  If the physician signature cannot be read, then the physician should print or stamp their name under the signature.  Everyone in the office and hospital may recognize that big S mark as Dr. Smith's signature, but Dr. Smith should still print JACOB SMITH under the mark.

These codes are for use when the patient's status is inpatient.

Subsequent hospital visits may be billed as shared services between a physician and qualified Non-Physician Practitioner.


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