CCO Admin asked:
Hi; I work for a teaching hospital this is what happened how should I code Resident saw the patient 2 days prior to the attending seeing the patient. I have a attestation on the chart. that is ok. this attestations is signed at 12/11/18 4/18 from attending. The resident who did the assessment signed off on 12/9/18 8:53 the day after patients operation would this be coded subsequent for consult or would it be billable as consult at all. Thanks for you time.
Answer:
Jennifer Sanders wrote: Does the note reference the attending/teaching physician was in attendance with the resident? Or did the attending see the patient after the resident and "agree" with their evaluation? In that case it is to be within 24 hours per CMS guidelines. It is "during or immediately after" per their rule. If it cannot be proved that the attending was there for medical necessity of the service provided; then I would go with the "immediately after" rule that the service cannot be billed.
Followup question:
Hi; I pulled out all HPI this is the note
Consults
Date of Service: 12/9/2018 4:07 PM
Attending; MD
Pediatric Neurology
Cosigned by: Resident MD at 12/11/2018 4:18 PM
Consult Orders:
1. Consult to Neurology [231684024] ordered by Mary J Bre; NP at 12/09/18 1603
Attestation signed by attending; MD at 12/11/2018 4:18 PM
I have seen and examined the patient on 12/11/18. I agree with the findings and plan of care as documented in the residents/fellows note.
I saw the patient the day after her operation
The patient is responsive to stimulation. She moves all 4 extremities symmetrically. She responds to touch.
I have personally reviewed the patients head ultrasound from today. This is a normal study.
We recommend obtaining a brain MRI when stable. Continue to follow neurological exams.
Pediatric Neurology Consult Note
Patient Name:
Medical Record Number
Date of Birth (DOB):
Encounter Date:
Requesting Provider: Dr. teamt (CICU)
Reason for Consultation: Patient at high risk for developmental delay (HLHS).
Subjective
Chief Complaint
Baby is a 3 days female seen today for baseline exam in a patient at high risk for developmental delay secondary to hypoplastic left heart syndrome.
HPI
Baby was born at Mercy Hospital to a 31 year old G2P1>2 mother at 39w5d EGA. Pregnancy was complicated by prenatal diagnosis of HLHS. Born via NSVD with birth weight 3515 grams. APGAR 6/8 at 1/5 minutes. Required suctioning; warming; and drying at birth. Following delivery patient was admitted to Mercy NICU. Initial vital signs reported as follows: O2 saturation 96.8%; HR 168; RR 80; BP 54/36. UVC and UAC were placed and prostaglandin infusion initiated. A post-natal echocardiogram confirmed HLHS with mitral atresia and aortic atresia. Infant was subsequently transported to the Saint Louis Childrens Hospital CICU for further management.
On her first day in the CICU; patient required epinephrine infusion and PRBC transfusion due to borderline systemic oxygen delivery in the setting of pulmonary overcirculation. She also received furosemide x 1 for tachypnea and pulmonary edema on CXR. This morning epinephrine was increased due to persistently low somatic NIRS. No other acute events since arrival to CICU. Head ultrasound obtained yesterday was normal.
Neurology was consulted for baseline exam prior to cardiac surgery planned for 09:00 on 12/10/2018 due to patients high risk for developmental delay.
Review of Systems
Constitutional: Negative for fever and irritability.
HENT: Negative for congestion and rhinorrhea.
Eyes: Negative for discharge or redness.
Respiratory: Negative for cough.
Cardiovascular: Negative for cyanosis.
Gastrointestinal: Negative for abdominal distention.
Genitourinary: Negative for decreased urine volume.
Musculoskeletal: Negative for extremity swelling.
Skin: Negative for color change and rash.
Past Medical/Surgical History
Details of birth and first 3 days of life summarized in HPI; above.
Medications
Current Medications
Current Facility-Administered Medications
Medication Dose Route Frequency Provider Last Rate Last Dose
Hi; I work for a teaching hospital this is what happened how should I code Resident saw the patient 2 days prior to the attending seeing the patient. I have a attestation on the chart. that is ok. this attestations is signed at 12/11/18 4/18 from attending. The resident who did the assessment signed off on 12/9/18 8:53 the day after patients operation would this be coded subsequent for consult or would it be billable as consult at all. Thanks for you time.
Answer:
Jennifer Sanders wrote: Does the note reference the attending/teaching physician was in attendance with the resident? Or did the attending see the patient after the resident and "agree" with their evaluation? In that case it is to be within 24 hours per CMS guidelines. It is "during or immediately after" per their rule. If it cannot be proved that the attending was there for medical necessity of the service provided; then I would go with the "immediately after" rule that the service cannot be billed.
Followup question:
Hi; I pulled out all HPI this is the note
Consults
Date of Service: 12/9/2018 4:07 PM
Attending; MD
Pediatric Neurology
Cosigned by: Resident MD at 12/11/2018 4:18 PM
Consult Orders:
1. Consult to Neurology [231684024] ordered by Mary J Bre; NP at 12/09/18 1603
Attestation signed by attending; MD at 12/11/2018 4:18 PM
I have seen and examined the patient on 12/11/18. I agree with the findings and plan of care as documented in the residents/fellows note.
I saw the patient the day after her operation
The patient is responsive to stimulation. She moves all 4 extremities symmetrically. She responds to touch.
I have personally reviewed the patients head ultrasound from today. This is a normal study.
We recommend obtaining a brain MRI when stable. Continue to follow neurological exams.
Pediatric Neurology Consult Note
Patient Name:
Medical Record Number
Date of Birth (DOB):
Encounter Date:
Requesting Provider: Dr. teamt (CICU)
Reason for Consultation: Patient at high risk for developmental delay (HLHS).
Subjective
Chief Complaint
Baby is a 3 days female seen today for baseline exam in a patient at high risk for developmental delay secondary to hypoplastic left heart syndrome.
HPI
Baby was born at Mercy Hospital to a 31 year old G2P1>2 mother at 39w5d EGA. Pregnancy was complicated by prenatal diagnosis of HLHS. Born via NSVD with birth weight 3515 grams. APGAR 6/8 at 1/5 minutes. Required suctioning; warming; and drying at birth. Following delivery patient was admitted to Mercy NICU. Initial vital signs reported as follows: O2 saturation 96.8%; HR 168; RR 80; BP 54/36. UVC and UAC were placed and prostaglandin infusion initiated. A post-natal echocardiogram confirmed HLHS with mitral atresia and aortic atresia. Infant was subsequently transported to the Saint Louis Childrens Hospital CICU for further management.
On her first day in the CICU; patient required epinephrine infusion and PRBC transfusion due to borderline systemic oxygen delivery in the setting of pulmonary overcirculation. She also received furosemide x 1 for tachypnea and pulmonary edema on CXR. This morning epinephrine was increased due to persistently low somatic NIRS. No other acute events since arrival to CICU. Head ultrasound obtained yesterday was normal.
Neurology was consulted for baseline exam prior to cardiac surgery planned for 09:00 on 12/10/2018 due to patients high risk for developmental delay.
Review of Systems
Constitutional: Negative for fever and irritability.
HENT: Negative for congestion and rhinorrhea.
Eyes: Negative for discharge or redness.
Respiratory: Negative for cough.
Cardiovascular: Negative for cyanosis.
Gastrointestinal: Negative for abdominal distention.
Genitourinary: Negative for decreased urine volume.
Musculoskeletal: Negative for extremity swelling.
Skin: Negative for color change and rash.
Past Medical/Surgical History
Details of birth and first 3 days of life summarized in HPI; above.
Medications
Current Medications
Current Facility-Administered Medications
Medication Dose Route Frequency Provider Last Rate Last Dose
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