General Surgery Coding Alert

4 tips could keep your practice from losing more than $2,400

If you report 99231 for all of your subsequent hospital care services, you may be costing your practice more than money. You could be raising a red flag to payers or marking yourself for an audit.
 
According to CMS data, general surgeons report 99231 more often than any other subsequent hospital care code. This indicates that either most subsequent hospital visits are low-level services or surgeons routinely undercode for inpatient care. But as long as your documentation warrants it, you should report higher-level subsequent hospital care.
 
Because carriers usually bundle hospital care into postsurgical visits, many general surgeons aren't familiar with the documentation guidelines associated with subsequent hospital care for nonsurgical situations. If you pick up the patient's care after another physician - such as a patient's primary-care physician - admits the patient to the hospital, you should report the 99231-99233 code range.
 
Use the following four tips to ensure you're properly assigning these codes. 1. Learn the Coding Levels You may believe that reviewing documentation is the first step to determine whether you can increase your inpatient coding levels, but that's actually the second step. If you don't know what constitutes each service level, reviewing the documentation won't help. So educate your practice regarding what CMS requires for each care level.
 
Here are basic guidelines for the three subsequent hospital care levels as a starting point for physician education, according to coding experts:

   99231 - Patient is stable, recovering or improving.
   99232 - Patient is responding inadequately to therapy or has developed a minor complication.
   99233 - Patient is unstable or has developed a significant complication or a significant new problem. If your practice routinely reports 99231 for all subsequent hospital care services, tell your physicians that this might raise red flags with your payer, coding experts say. For example, a carrier may identify your practice for "poor quality of care" because you consistently report low-level codes. If you submit only 99231, the payer may interpret that as saying all hospital patients, regardless of their conditions, only receive a problem-focused history and exam. This can indicate to managed-care plans that your physicians never take a complete history and never perform comprehensive exams.
 
"This may also indicate the same to Medicare because they keep profiles on every physician handling Medicare patients," says Judy Richardson, RN, MSA, CCS-P, senior consultant at Hill & Associates, a coding and compliance consulting firm based in Wilmington, N.C. "In addition, although Medicare originally started examining providers who were consistently billing the higher levels of service, it decided a few years ago to also examine providers billing the lower levels."

2. Use Medical Decision-Making to Choose a Level Of the three [...]