Low level Inpatient Consultation= Initial or subsequent

I have written to CMS about the MAC's claiming that a low level consultation on an inpatient should be billed as a subsequent visit (or unlisted code) even though it is an initial visit. I think this is blantantly wrong.

Trailblazer http://www.trailblazerhealth.com/Tools/Notices.aspx?DomainID=1&id=13472 referred to the CMS publication R1875CP in their explanation. http://www.cms.hhs.gov/transmittals/downloads/R1875CP.pdf

But to further my argument, that very document has the example of an observation patient then converted to inpatient on a subsequent day. The transmittal says: "The physician may not bill an initial observation care code for services on the date that he or she admits the patient to inpatient status. If the patient is admitted to inpatient status from hospital outpatient observation care subsequent to the date of initiation of observation services, the physician must bill an initial hospital visit for the services provided on that date."

If I did the comprehensive work for the Initial Observation visit and then admit the patient on the next day, I would not do another complete H&P; I would write a note that looks like a subsequent visit in SOAP format and write "Admit to Inpatient." This clearly does not meet the documentation requirements of an Initial Hospital Visit" but CMS says I MUST BILL AN INITIAL HOSPITAL VISIT!!!!!

Low level Inpatient Consultation= Initial or subsequent

I listened in on the CMS Open Door Forum Feb 2 2010. There were many complaints/concerns about this topic. Dr. Rogers said that they were working on a clarification. I inferred that there would be a national policy soon. He did not say when it would be released.