Primary Care Coding Alert

When family physicians (FPs) along with other specialists treat patients in the hospital, the coding can be problematic. Because two or more physicians are billing subsequent hospital care codes (99231-99233) for the same patient on the same day, Medicare and private payers may deny the claims. FPs can increase their chances of receiving reimbursement for providing concurrent care by using a primary diagnosis code that is different from that of the other specialists.

"When the payers see multiple doctors billing the same diagnosis codes for the same patient on the same day, they may not pay," says Mary Falbo, MBA, CPC, president of Millennium Healthcare Consulting Inc., a healthcare consulting firm based in Landsdale, Pa. "There are no concurrent care CPT Codes , so the only way to tell the payer that you're providing services separate from another specialist is to use a different primary diagnosis code." Too often, Falbo says, FPs providing concurrent care use the reason the patient is in the hospital as their primary diagnosis code. "They should use the reason they were called in to treat the patient," she says. "They shouldn't even include the diagnosis code for why the patient is in the hospital unless it directly relates to the condition they are treating."

CMS defines concurrent care as "when services more extensive than consultative services are rendered by more than one physician during a period of time. The reasonable and necessary services of each physician rendering concurrent care could be covered where each is required to play an active role in the patient's treatment, for example, because of the existence of more than one medical condition requiring diverse specialized medical services." It is usually provided when two or more separate conditions require two or more doctors for proper management of a patient. Medicare allows concurrent care to be billed for up to six different specialists treating one patient. Medical-Surgical Concurrent Care An FP is often called on by another specialist to treat a post- or preoperative patient for conditions unrelated to the surgery. "Although the FP is not in charge of the case, his or her particular skills are required," says Daniel S. Fick, MD, director of risk management and compliance for the College of Medicine faculty practice at the University of Iowa in Iowa City. "It happens often when the FP is familiar with that particular patient's history. The surgeon may call the doctor in to treat a condition that he or she has been managing for a while."

For example, a patient taking Coumadin for his atrial fibrillation has to stop taking the medication to prepare for hip replacement surgery. After [...]