Palliative Care Consultations

We are trying to determine the best way to bill for services for our nurse practitioner who primarily works Palliative care. If she sees a patient on day one in the ICU unit with the intent to do a consultation but the patient is too unstable to participate after 30 minutes of time and documentation, so she aborts this attempt and comes back on day two to do the consult. What can she bill for day one?
Her thoughts:
Day one- Low level consult
Day two- high level daily care plus prolonged care

Day one- nothing and carry the documentation forward into the high level consult day two

Day one- daily care

Any thoughts would be appreciated as well as anyone who does coding and documentation reviews for Palliative care that would be willing to share insight into the documentation process would be greatly appreciated.

Thank you,

Medcoder

Look at the $$

It should be a financial decision. What pays more- level 1 consult on day 1 and high level subsequent visit on day 2 or high level consult day 1 and low or medium level visit on day 2.
As to documenting, I have not seen anything special for your specialty (or any specialty besides single system exams) so you are bound by usual E&M rules.

Palliative Care Consultations

Thank you for responding.

Medcoder

Pallitative care consultations

The billing and coding should follow what was done, and documented. There's no provision in CPT for providing half of the service one day and the other half the next day. It's always hard without seeing the documentation, but it sounds like low level consult day 1, based on the history, exam and MDM (or time, IF it meets the criteria for time) and a subsequent hospital visit the next day.

Prolonged services require face to face time.

Pallilative Care

Thanks for the comments.