Daily Care Conundrums

The Hospitalist. 2008 January;2008(01):

January 1, 2008|The Hospitalist

Subsequent hospital care, also known as daily care, presents a variety of daily-care scenarios that cause confusion for billing providers.

Subsequent hospital care codes are reported once per day after the initial patient encounter (e.g., admission or consultation service), but only when a face-to-face visit occurs between provider and patient.

The entire visit need not take place at the bedside. It may include other important elements performed on the patient’s unit/floor such as data review, discussions with other healthcare professionals, coordination of care, and family meetings. In addition, subsequent hospital care codes represent the cumulative evaluation and management service performed on a calendar date, even if the hospitalist evaluates the patient for different reasons or at different times throughout the day.

Code of the Month

SUBSEQUENT CARE

99231: Subsequent hospital care, per day, for the evaluation and management of a patient that requires at least two of three key components:

A problem focused interval history;
A problem focused examination; or
Medical decision-making that is straightforward or of low complexity.

Counseling and/or coordination of care with other providers or agencies is provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the patient is stable, recovering, or improving. Hospitalists typically spend 15 minutes at the bedside and on the patient’s hospital floor or unit.

99232: Subsequent hospital care, per day, for the evaluation and management of a patient that requires at least two of three key components:

An expanded problem-focused interval history;
An expanded problem-focused examination; or
Medical decision-making of moderate complexity.

Counseling and/or coordination of care with other providers or agencies is provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Hospitalists typically spend 25 minutes at the bedside and on the patient’s hospital floor or unit.

99233: Subsequent hospital care, per day, for the evaluation and management of a patient that requires at least two of three key components:

A detailed interval history;
A detailed examination; or
Medical decision-making of high complexity.

Counseling and/or coordination of care with other providers or agencies is provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the patient is unstable or has developed a significant complication or a significant new problem. Hospitalists typically spend 35 minutes at the bedside and on the patient’s hospital floor or unit.

These codes are used for new or established patients. An established patients has received face-to-face services from a hospitalist or someone from the hospitalist’s group within the past three years. The hospitalist does not have to spend the associated “typical” visit time with the patient to report an initial hospital care code. Time is only considered when more than 50% of the total visit time is spent counseling/coordinating patient care. See Section 30.6.1C, www.cms.hhs.gov/manuals/downloads/clm104c12.pdf for more information about reporting visit level based on time.

Concurrent Care

Traditionally, concurrent care occurs when physicians of different specialties and group practices participate in a patient’s care. Each physician manages a particular aspect while considering the patient’s overall condition.

When submitting claims for concurrent care services, each physician should report the appropriate subsequent hospital care code and the corresponding diagnosis each primarily manages. If billed correctly, each hospitalist will have a different primary diagnosis code and be more likely to receive payment.

Some managed-care payers require each hospitalist to append modifier 25 to their evaluation and management (E/M) visit code (99232-25) even though each submits claims under different tax identification numbers. Modifier 25 is a separately identifiable E/M service performed on the same day as a procedure or other E/M service. In this situation, Medicare is likely to reimburse as appropriate.