Reader Question:
Courtesy Visits
Published on Tue Feb 01, 2000
Question: As a primary-care pediatric office, we like to stop in and see our patients and their families when they are hospitalized, but not on our service. We are finding that it is becoming more frequent and are wondering if we could bill for these courtesy visits. Is there an appropriate procedure code we could be using?
Barbara Bennett, Office Manager
Kenmore Pediatric Associates, Buffalo, N.Y.
Answer: If this is truly a social visit, in which you stop by to say hi, the answer is no, you cannot bill for it. This does happen often. But there are many occasions on which a pediatrician might stop by to see a child who is hospitalized by another serviceperhaps in a different hospital from the one you have privileges atand you could bill. First of all, if the attending physician requests that you see the child, that is clearly a consultation (99251-99255 for initial, 99261-99263 for follow-up). Whether initial or follow-up, the consultation must be requested by the attending physician. Take the case of a child who is hospitalized by an orthopedic service. The child has a fractured femur and is in traction. During the hospitalization, the child develops a fever and a sore throat. The orthopedist is not comfortable treating these symptoms and consults the pediatrician.
This is clearly a medical issue, not a social issue, and it is rarely denied. A similar situation might arise if the child in traction becomes somewhat depressed. The orthopedist, again, would probably consult the pediatrician, who could bill a consultation code for visiting the child to review behavioral issues related to the hospitalization.
Following is a real-life scenario which falls in between the purely social visit and the purely medical consultation:
A four-month old, healthy baby, except for some reflux, born full-term, develops RSV and is hospitalized by the primary care pediatrician in the local hospital, which is in a rural area. The baby aspirates formula while hospitalized for RSV. The baby is transferred to the nearest hospital with ECMO capabilities, which happens to be a military hospital. The mother is 14 years old, and the baby is doing so poorly that the pediatrician wants to visit just to let the mother know that Were still there.
This visit could, obviously, become quite prolonged, between discussions with the mother and the attending physician, but the pediatrician travels the 30 miles to the military hospital. And the attending physician, even though he didnt specifically request a consultation, tries to get the assistance of this primary-care pediatrician in dealing with the childs family.
It becomes quite a time-consuming social visit, a far cry from stopping in to say hi to a child in [...]
