Part B Insider (Multispecialty) Coding Alert
Choose the Right Service Level Code for Subsequent Hospital Care
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To claim 99231-99233, you must meet 2 of the 3 key E/M components
Your ED physician may provide subsequent hospital care to patients for several reasons, including contractual obligations, after-hours resource limitations, or general clinical responsiveness.
Caution: Be careful when selecting a code from this family, because 99231-99233 claims have different reporting rules than the standard ED E/M services .
What to do: When you are choosing a service level for subsequent hospital care, you’ll select from among these codes:
• 99231--Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: a problem-focused interval history; a problem-focused examination; medical decision-making that is straightforward or of low complexity
• 99232--... an expanded problem-focused interval history; an expanded problem-focused examination; medical decision-making of moderate complexity
• 99233--... a detailed interval history; a detailed examination; and medical decision-making of high complexity.
For most ED E/M services, such as 99281-99285 (Emergency department visit for the evaluation and management of a patient ...), you must meet all three key components in their E/M description--history, physical exam, and medical decision-making (MDM). To claim 99231-99233, however, the physician only has to meet two of the three key E/M components, says Mary Falbo, MBA, CPC, president of Millennium Healthcare Consulting Inc. in Lansdale, Pa.
Example: An ED physician provides subsequent hospital care to a patient. The notes indicate that he performed an expanded problem-focused interval history with a problem-focused examination. MDM was of moderate complexity.
“You only need to have two out of three elements, so if the notes indicate [level-one] exam, but indicate interval history and MDM are level two, then that’s all you need,” says Catherine Brink, CMM, CPC, president of Healthcare Resource Management of Spring Lake, N.J.
Solution: On the claim, report 99232 for the service.
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