Wiki Advice 99233

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Location
Salisbury, NC
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I work for a Cardiology practice of 8 physicians. Today they have questioned why I mainly bill level 2s for their hospital rounds. Their arguments are if a patient has congestive heart failure, or if they are post CABG, or if a patient is admitted for a tikosyn load then that should qualify them as a critical patient, which should boost their code. Documentation wise they will document, "patiently is post CABG, examine 5-6 systems, then list all of the cardiac and chronic diagnosis'. I'm feeling quite pressured from this. My question is how do you explain leveling to your physicians? I don't have a compliance person to speak with, or a practice manager that is knowledgeable about coding.
 
This became an easy one to solve when I showed my boss the "usually..." section for each code:

99231: Usually, the patient is stable, recovering, or improving. Typically, 15 minutes are spent at bedside or on the floor or unit.
99232: Usually, the patient is responding inadequately to therapy or has developed a minor problem. Typically, 25 minutes....
99233: Usually, the patient is unstable or had developed a significant complication or a significant new problem. Typically, 35 minutes...

Once I showed him that (I had already showed him the documentation requirements), then he "got it". Now he thinks of it as 1-doing well; 2-not doing so well; 3-we got problems, chief.
 
I would explain that risk is only one element that helps to determine the visit level. I would also complete audit forms for some of the charges, making detailed notes about what you are giving credit for and why (if it's not obvious) and review the audits with them to show why it meets the billed level. I hope others have better advice for you; that's a tough situation to be in.
 
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