Neurologists Benefit From New Medicare Policy Increasing RVUs For Hospital Care Codes
Published on Mon Jan 01, 2001
Effective Jan. 1, 2001, Medicare has revised its payment policy for observation and inpatient hospital care services when the patient is admitted and then discharged more than eight hours later on the same day. Despite the policys revision, however it is still at odds with CPT coding instructions, which state that 99234-99236 (observation or inpatient hospital care) should be used to report observation or inpatient hospital care services for patients admitted and discharged on the same date of service.
CPT doesnt differentiate by time and doesnt require the stay to be eight hours or more to bill 99234-99236, says Catherine A. Brink, CMM, CPC, president of Healthcare Resource Management Inc., a physician practice management consulting firm in Spring Lake, N.J., that consults with several neurology practices. If the stay goes into the next calendar day, then CPT says to report both an admission and a discharge.
According to Kathleen Mueller, RN, CPC, CCS-P, a physician reimbursement specialist in Chester, Ill., in some cases, the insurance carrier will not authorize an inpatient admission, but will authorize an observation stay because it costs less. Any subsequent admission to the hospital would have to be authorized by the carrier and then billed accordingly, Mueller says. A neurologist may admit a patient to observation or inpatient hospital care services for less than a day for a variety of reasons. For example, a patient who is being treated for a sports-related concussion (850.0) may be admitted to observation for persistent low-grade headaches (784.0). Also, if the patient is suffering from poor attention and concentration after a concussion, a neurologist may admit the patient to observation.
99234-99236 Pays More Than Initial Care Codes
As stated in sections 15504.b and 15505.1(c) of the Medicare Carriers Manual, the previous policy had allowed the reporting of only an admission code for observation/inpatient hospital stays when the patient is admitted and discharged on the same day.
Under the new policy, however, neurologists may code 99234-99236 for observation or inpatient hospital stays when the patient was admitted and then discharged more than eight hours later on the same day. Because these observation or inpatient hospital care codes include both an admission and a discharge in their descriptions, they have higher relative value units (RVUs) than the initial observation or hospital care codes.
With the new Medicare policy, for example, a neurologist may admit a patient for observation, take a comprehensive patient history, perform a comprehensive examination and do medical decision-making of moderate complexity. The patient is discharged more than eight hours later, but on the same day. The neurologist may then report 99235, which has a 2001 transitioned facility RVU of 4.74. Under the old policy, only 99219, which [...]
