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Admission H&P by other than admitting MD

  1. #1
    Default Admission H&P by other than admitting MD
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    Scenario: ER doctor calls Dr. X and Dr. X says to admit the patient over the phone. Later that day or the following day, Dr. M performs the actual initial hospital H&P, not Dr. X. How do you bill for Dr. M's services? CPT directs that "for initial inpatient encounters by physicians other than the admitting physician, see initial inpatient consultation codes or subsequent hospital care codes as appropriate". Dr. M did not see the patient at Dr. X's request so you cannot bill a consultation.
    Heather Winters, CPC, CFPC

  2. #2
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    Greeley, Colorado
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    Dr. M gets the admit code. He/she did the actual H&P and saw the patient whcih technically makes Dr. M the admitting physician. Dr. X cannot code the admit.
    Lisa Bledsoe, CPC, CPMA

  3. #3
    Default Initial H&P by other than admitting MD
    I just found this article on the subject, any thoughts?
    http://www.aafp.org/fpm/20020500/coding.html

    Initial hospital care codes
    Q Often an on-call doctor will see one of my patients and call in the admission to the hospital, but I'll do the history and physical associated with the admission. The local Medicare carrier is denying these claims for initial hospital care, since the on-call doctor is identified as the admitting physician. As the patient's attending physician, shouldn't I be able to bill for the initial hospital care?
    A No, you should not submit the initial hospital care codes if you are not the admitting physician, even if you are the attending physician and do a history and physical during your initial hospital encounter with the patient. CPT is very clear that the initial hospital care codes (99221-99223) should be used to report "the first hospital inpatient encounter with the patient by the admitting physician." The CPT manual states that "for initial inpatient encounters by physicians other than the admitting physician, see initial inpatient consultation codes (99251-99255) or subsequent hospital care codes (99231-99233) as appropriate." The Medicare Carriers Manual (MCM) has similar advice: "Consider only one MD or DO to be the admitting physician, and permit only the admitting physician to use the initial hospital care codes. Advise physicians that if they participate in the care of a patient but are not the admitting physician of record, they should bill the inpatient evaluation and management [E/M] services codes that describe their participation in the patient's care (i.e., subsequent hospital visit or inpatient consultation)."
    Note that the dates of service and whether the admitting physician actually bills for the admission are not relevant to the issue of whether you, the attending physician, can bill for initial hospital care. The admitting physician can bill an initial hospital care code on the date the patient enters the facility or on another date as long as it represents "the first hospital inpatient encounter with the patient by the admitting physician." Of course, if the admitting physician does not do the work associated with the initial hospital care codes (i.e., the history, exam and medical decision making required by CPT), he or she should not bill for initial hospital care either. In this case, the opportunity for anyone to bill for initial hospital care is lost.
    Last edited by heatherwinters; 02-09-2009 at 10:58 AM.
    Heather Winters, CPC, CFPC

  4. #4
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    Maybe my interpretation is incorrect, but the question states that "an on-call doctor will see one of my patients and call in the admission..." I think if the on-call doctor simply tells the ED doc to admit the patient then whoever does the initial H&P should get to code the admission. To me, the admitting physician of record would be the one who does the H&P. Anyone else?
    Lisa Bledsoe, CPC, CPMA

  5. #5
    Location
    Milwaukee WI
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    4,466
    Default Dr M and Dr X in the same practice?
    Are Dr M and Dr X in the same practice and using the same tax ID?
    If the answer to that question is YES ... Then I believe that Dr M would appropriately code the initial hospital visit.

    If they have no professional relationship and are in two completely different practices, then Dr M will code the appropriate level of subsequent hospital visit as per his documentation. Dr X will code the initial hospital visit if and when s/he performs that service.

    F Tessa Bartels, CPC, CEMC

  6. #6
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    Good point Tessa. I was looking at it as if the two were in the same practice.
    Lisa Bledsoe, CPC, CPMA

  7. #7
    Default Thank you
    Thank you for your input :-)
    Heather Winters, CPC, CFPC

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