It may just depend on your documentation.
I will leave this unanswered so a coach can chime in as well.
Payment for Initial Hospital Care Services (Codes 99221 - 99223)
Initial Hospital Care From Emergency Room Carriers pays for an initial hospital care service or an initial inpatient consultation if a physician sees his/her patient in the emergency room and decides to admit the person to the hospital. They do not pay for both E/M services. Also, they do not pay for an emergency department visit by the same physician on the same date of service. When the patient is admitted to the hospital via another site of service (e.g., hospital emergency department, physician’s office, nursing facility), all services provided by the physician in conjunction with that admission are considered part of the initial hospital care when performed on the same date as the admission.
Two hospital visits on the same day
Physicians often see their hospitalized patients more than once in a single day. The patient's condition may require frequent visits, or the physician or covering partner may be called back to the hospital because the patient's condition worsens. It is a source of huge frustration to physicians that they do not get paid extra for multiple visits.
All of the hospital services (initial or admissions, subsequent or rounding and discharge day services) are defined by both CPT® and CMS as per diem services, as the care of the patient for the entire calendar date. That means, there is no extra reimbursement or RVUs for the second visit, whether performed by that physician or a covering partner.
Medicare, and other payers, pay for physicians in a group of the same specialty as if they were the same physician. They don't differentiate between the two.
If the patient is critically ill, there is additional payment for additional services provided. Be careful: just because a physician is called back to see an ill patient does not mean critical care can be reported. Review the requirements for critical care.
Sometimes, prolonged services may be reported. Again, use caution to be sure that the services being reported were all face-to-face services. Although CPT® changed their definition of prolonged services in a hospital to be unit time, CMS did not. CMS still requires that prolonged services provided in the office or hospital setting be face-to-face time with the patient.
<p>There are times when physicians or NPPs see a patient twice in a single day, and want to know if both are reportable, and if both are paid by insurances...
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inpatient billing can be tremendously confusing, given the complexity of patients and the number of physicians called in to treat them. That makes untangling billable services a real challenge, with physicians and coders struggling to determine who provided which services and how those services should be billed.
Adding to the confusion are shift changes, critical care time, add-on codes and specialty designations. So how do you make sure that you’re capturing all the revenue you’re due?
In figuring out how to navigate your way through billing choices, keep in mind that the descriptors for both initial hospital visits (99221-99223) and subsequent visits (99231-99233) contain the phrase "per day" to designate services provided during an entire day.
"Per day" refers to one specific calendar date, not a 24-hour time period. You can bill only one visit per day, whether that’s an admission or a subsequent visit, so your "one-a-day" claim needs to include all the services provided by all the physicians of the same specialty within your group. That means that you should combine all physician visits and services (for your group) during that calendar day, and select the code that reflects the sum of the work provided.
Any time multiple physicians are caring for the same patient, they must establish and document the medical necessity of each of their services.
What this often means is that two physicians billing for the same patient on the same date of service will likely need different diagnoses to avoid a denial, regardless of whether or not those doctors belong to different specialties and/or groups.
Remember too that you’ll have to rely on documentation to appeal a claim if it’s denied. Make sure your documentation clearly reflects the diagnoses you addressed and the full picture of the patient’s illness, as well as the medical need for your services.
Read “More than one doctor? It gets complicated ” and other informative articles in Today’s Hospitalist. Follow us for news & tips in the medical career field.
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