Use of Time May Boost Reimbursement for Subsequent Care Codes
Published on Mon Jan 01, 2001
The subsequent hospital care visit codes (99231-99233) are among the top 10 CPT codes reported by gastroenterologists, according to data compiled by HCFA. Although these codes are frequently reported, gastroenterologists may be underreporting the level of visit that was performed because these codes are defined in a slightly different manner than other evaluation and management (E/M) codes. To avoid underreporting, gastroenterologists should use time spent counseling and coordinating care as a gauge to help them determine the level of visit performed and use a prolonged care code to report extremely long patient visits.
High-level Interval History Not Hard to Achieve
The subsequent hospital care codes are commonly used by gastroenterologists to report daily visits to their hospitalized patients, according to Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and a former member of the CPT Advisory Panel. If you are listed as the primary care physician for a patient in the hospital, you should be seeing them every day whether he or she is stable or not.
One of the unusual features of these codes is that interval history is one of the key components, along with examination and medical decision-making that determines the level of subsequent hospital care to report. (For subsequent care codes, only two of the three key components need to be considered.) The interval history is what has happened to the patient in the past 24 or 48 hours, Weinstein explains.
Gastroenterologists may feel that it is hard to accumulate the number of elements in a patient history required by CPT and Medicare to report a high-level history. But it is not that difficult, according to Weinstein. Gastroenterologists need to remember that the highest level of subsequent care (99233) requires only a detailed interval history, not a comprehensive history as required by other high-level E/M codes. According to evaluation and management documentation guidelines issued by CPT and Medicare, a detailed interval history contains the following:
Chief complaint;
Extended history of present illness (HPI). Four or more elements, or three or more chronic or inactive conditions if the 1997 Medicare E/M guidelines are being followed; and
Problem-pertinent review of systems (ROS) extended to include a review of a limited number of additional systems (two to nine systems).
Its relatively easy to get a high-level history even when its an interval history, Weinstein says. A gastroenterologist will ask a patient with Crohns disease, for example, whats happening with his or her pain, diarrhea, or nausea and if theres been any bleeding.
For an interval history, the HPI and ROS will be the only elements considered. With the Crohns disease patient, the gastroenterologist will be checking to see if the patient is having a reaction [...]
