Cardiology Coding Alert

Question: We have two patients that go into the hospital once a week for Med IV treatment for cardiomyopathy and congestive heart failure, and they stay for five to six hours. I was coding observation status 99218 (initial observation care, per day, for the evaluation and management of a patient; requires detailed or comprehensive history and examination, and medical decision-making that is straightforward or of low complexity). Medicare paid for a couple and then started to deny the rest. When I questioned them, they said the code requires a discharge and I never billed for a discharge. So I'm not sure how to bill. Should it be coded outpatient with office visit, or perhaps a 99234 (observation or inpatient hospital care for the evaluation and management of a patient including admission and discharge on the same date [same components as 99218])?

Norma Sprague
Bennington Cardiology, Vt.

Answer: Yes. The 99234 would be correct because it includes both admission and discharge services. To bill appropriately for this or any observation, however,
cardiologists should remember that the physician actually must examine the patient at some point during the infusion.

You cant just let the hospital administer the treatment. The doctor has to be there, show up and do a face-to-face with the patient, and has to provide whatever level of history and physical and decision-making to justify that level of evaluation and management, says Susan Callaway-Stradley, CPC, CCS-P, a coding specialist and educator in North Augusta, S.C. She notes that with patients who visit the hospital regularly for infusions, physicians often do not show up and the patient receives the infusions and any other necessary care from a nurse.