Pediatric Coding Alert

Question: How would you bill for a hospital intensivist who handles a critical patient brought from another hospital? In this case, the intensivist does all the documentation, but the child ends up admitted to floor rather than the unit, and the intensivist doesnt see or examine the child. Is there any way to bill for the time and risk involved?

Maryland Subscriber

Answer: It is important to bill for this, because the decision-making of the intensivist was critical. The physician needed to make a decision in terms of the transfer. This is really a consultation, with the transferring hospital asking the physician to consult in the case. The physician cant use the critical care codes, however, because it turned out that the child was not critical enough for them. The intensivist will need to pick a level of consultation (99251-99263) based on the time spent, if there is an exam. If the intensivist doesnt do an exam, then he or she cannot bill a consultation. The intensivist should indicate that he or she received a call from the transferring hospital and make sure to document the amount of time spent on the case.