Coding for a Covering Physician

djc822

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I have a provider (A) who is covering for another physician (B). He has seen a number of this physicians (B) patients in the hospital setting and coding these visits as subsequent (including the first visit). Since he was not the admitting physician, I believe he should be coding the initial visits (on day other than admission) as initial inpatient consultation and subsequent thereafter. This I based on the CPT guidelines which are stated under “Initial Hospital Care”.
He also states that if he sees a patient in the office, as a covering provider, it is a new patient to him, hence he would code as new patient. In this situation, he should be coding it as an established patient since he is covering for patients primary doctor. Again, this is based on CPT guidelines for New and Established patients. I want to make sure I am not missing anything and that going forward the doctor and I are on the same page. Input would be greatly appreciated.

Dawn, CPC-A
 
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For office visits, if the patient has previously been seen by another provider in the same group in the past 3 years, then it would be an established patient. In other words, it's based off whether the patient is new to the group, not new to the provider.

As far as billing for consultations, the criteria has to met, including a formal request by another provider to evaluate a patient for a specific reason and provide a written report back to the requesting provider. The 3 R's - Request, Reason, Report. In order to bill for an inpt consult, the same rules apply. "Covering" for another provider wouldn't qualify on its own. If the provider is seeing the patients on days when the original provider isn't to provide the daily evaluation and mgmt, they would be subsequent care codes.
 
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