Billing Alternatives for Crisis Hospital Visits on the Same Day
Published on Fri Oct 01, 1999
Sometimes a call comes in the early-morning hours. It is from the hospital; the pediatrician is being summoned because a patient is in crisis. The coding dilemma involved in this scenario is that the patient will be seen again, later that same day, by the pediatrician. How can you code for the 2:00 a.m. visit to the hospital as well as the regular rounds done later that day? You cant bill for two evaluation and management (E/M) services on the same day. The subsequent hospital care codes (99231, 99232 and 99233) can be used only once per day, as well.
There are several alternatives to this problem. The main choice is between coding to a higher level, or using different codesespecially critical care codesthat might be appropriate.
1. Coding to the next level. This is probably the simplest way of handling the chargeand you will have to do it regardless of what other codes you use. You take the complexity of the visits and the time involved, and add them up to come up with a higher-level visit, says Richard H. Tuck, MD, FAAP, of Primecare Pediatrics in Zanesville, OH. This isnt perfect, because almost by definition, any call you get that necessitates you going to the hospital in the middle of the night is likely to be a CPT 99233 . The fact that you came in at 2:00 a.m. almost always means the visit involves high medical decision-making, says A.D. Jacobson, MD, FAAP, of Pediatric Associates in Phoenix, AZ, and editor of the AAPs Coding for Pediatrics. So in any event, you will probably be coding 99233 once for the 2:00 a.m. visitno matter how many times you see the child later on during that day, or how intensive the child is. But this drawback can be more tolerable by the fact that you may be performing other procedures in addition to the hospital visit itself (see item 2 below). One example would occur when a child is admitted with abdominal pain, says Jacobson. You dont know what the problem is, and the child seems to be doing well. Then, at 2:00 a.m., the child has severe pain. You go in and see him, and you call the surgeon, says Jacobson. The surgeon comes in at 5:00 a.m., and its appendicitis. Then you see the child postop. This would be a 99233 for the day, says Jacobson.
2. Billing for procedures. There may be services you are performing as well as the visit in the middle of the night, says Jacobson. A typical scenario is when a child is admitted with a diagnosis of croup. The child gets worse at night, and the pediatrician is called. [...]
