Internal Medicine Coding Alert
TPN Coding by Physician
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Question: I have a physician who billed an E/M service (99232) for a hospital patient. She also oversaw the TPN (total parenteral nutrition) for this patient. Can both the subsequent hospital care and the TPN be billed? If so, which code would be used for the TPN? Michigan Subscriber Answer: The physician can code only 99232 (Subsequent hospital care, per day, for the evaluation and management of a patient) for this patient's care. The hospital bills for the TPN (total nutrition administered to the patient through a central line) because this service is generally ongoing and supervised by the hospital staff. Physician oversight usually includes checking lab values and writing orders for any changes to the TPN, but does not involve a significant amount of time beyond what is covered in the hospital visit code. Payers are aware that physicians do not have to spend time at the patient's bedside when TPN is being administered and do not reimburse physicians for these services.
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