Gastroenterology Coding Alert

Question: An established Medicare patient with a plan of care in place for his gastroesophageal reflux disease (GERD) suffers acute myocardial infarction (MI) and is hospitalized. A cardiologist is overseeing the patient's MI care, but the gastroenterologist continues to see the patient while he's in the hospital to manage his GERD. Yesterday, the gastroenterologist performed a level-two hospital E/M for the patient just after the cardiologist had finished his visit with the patient for ongoing care of the MI. Are there going to be problems when we code for services, since another physician provided the patient with care on the same day?

Connecticut Subscriber

Answer: In this case, each physician is treating a separate patient problem, so you should be able to code concurrently without any problems -- just get your diagnoses correct.

It is vital that each physician provide diagnosis codes to explain the exact patient problem he is treating. On the claim, report the following:

• 99232 (Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at  least 2 of these 3 key components: an expanded problem focused interval history; an expanded problem focused examination; medical decision making of moderate complexity ...) for the E/M

• 530.81 (Other specified disorders of esophagus; esophageal reflux) to represent the patient's GERD

• a code from the 410.x (Acute myocardial infarction ...) set appended to 99232 to represent the patient's MI.

Let's say the cardiologist performs a level one hospital E/M on the patient in your scenario. If he codes 99231 (... a problem focused interval history; a problem focused examination; medical decision making that is straightforward or of low complexity ...) with 410.x as the primary diagnosis, each should get paid without any problems.

Caveat: If both physicians use the same diagnoses in the same order in this situation, it is very likely that one of them will not get paid.