Wiki Therapy Codes vs E/M Codes

[jaud63]

I am presently working on a Contract coding for Professional Fees for inpatient services.

I have been given instruction to bill for Therapy related services using E/M codes for hospitalist services within global periods of surgeries. Both the surgical service professional fee and the evaluation and management services would be billed using the outpatient claim form with the inpatient POS.

Government guidelines state that therapy is a Part A facility service using the physical therapy codes and revenue codes or an outpatient place of service CPT physical therapy code.

Does anyone know if the hospitalist services would ever be billable in any circumstance if the hospital employs Certified Therapists and Therapy Assistants who are providing the therapy while the patient is still in the hospital? There are also situations where the patient requires physical therapy 2 months after a surgical service (Ex: Craniotomy;90 day global) and may remain or be readmitted to the hospital for the therapy within the global surgery service date.

 

[thomas7331]

I'm confused by your questions as to what exactly is the situation you're describing. Are the hospitalists doing physical therapy procedures and you're being asked to bill them as E&M codes, or are the hospitalists performing E&M services as part of an inpatient facility stay for which the patient is receiving therapy during a global period?

You're correct that physical therapy is a facility service, but I'm not sure why the fact that a hospital employs therapists would have any bearing on being able to bill hospitalist services, unless for some odd reason the hospital is having the hospitalists actually perform physical therapy. Being in the global period of a surgery is also likely not a factor here because hospitalists are generally not of a surgical specialty. If the hospitalists are providing medically necessary management of the patient during the stay, I can't think of a reason why they would not be able to bill their E&M services. But perhaps I'm not completely understanding what you're being asked to do here, if you could clarify.

 

[jaud63]

Hospitalist Charges

In these instances the hospitalists are documenting evaluation and management services within the global period of surgery with diagnosis that are relative to the surgery and the therapists/therapy assistants are documenting the actual therapy notes. All of these services are documented in a shared EMR. We are being requested to bill for the evaluation and management services on the professional fee side (outpatient HCFA) and there has not been any reference to our group that we are to bill for the facility therapy services (facility UB). I assuming that the hospital is aware that this is a Medicare Part A service and is billing the therapy on the facility claim. One example of a diagnosis that has been given to bill for the hospitalist therapy evaluation and management service is "pain" however, this would be considered a normal condition of healing in a global period managed by pain medications that would have been ordered by the Surgical team.

 

[thomas7331]

If the patient is confined for an extended stay, it's standard practice and the policy of most hospitals that a physician see the patient daily and that isn't necessarily part of routine post-operative care. It's to be expected that you'll see some overlap with the surgeon's post-operative work since that is relevant to what the hospitalists are doing to manage the patient's care. Consider that it would be the same if the patient was discharged and saw their PCP to follow them during the post-operative period - the PCP would need to evaluate and document relevant information about the recovery, but that would not mean the PCP's services are excluded due to a global period. Presumably if it's medically necessary for the patient to be hospitalized, then it's also medically necessary for the hospitalists to provide management.

As a coder, I wouldn't challenge this as it's getting into an area and outside of coding expertise and responsibility. If you're seeing something in the notes that looks very suspicious, or are concerned about the medical necessity/compliance aspect of the services, then you might consider discussing it with your client's compliance officer, but I wouldn't make an independent coding decision on this point without their participation. As mentioned above, for coding purposes and per guidelines, global periods only apply to providers of the same specialty and so it shouldn't affect coding for hospitalists or providers of other specialties. The surgeons would still be responsible for their portion of surgical post-operative management, but if the patient requires medical management by a physician of a different specialty during that time, that is excluded from the global package.

As far as the therapy, yes, the facility would be responsible for billing that. On an inpatient claim, there won't be any actual 'coding' for the therapy, just charges - it will appear as a single line item total dollar charge on the claim with no CPT codes, and won't affect reimbursement in most cases since the facility contracts are usually case, DRG or per diem rates.

 

[jaud63]

Thank you for your input. It's much appreciated.