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Post-Op Services by Pediatric Intensivist

  1. Red face Post-Op Services by Pediatric Intensivist
    Medical Coding Books
    By the surgeon's order, patient is sent post-operatively to the Pediatric ICU. The intensivist there dictates an extensive history, exam and assessment & plan for the patient as this is the first time the physician has seen this patient. Intensivist wants to bill a Consult; however, it appears to me that the surgeon is transferring care rather than asking for an opinion or recommendation.

    Question 1: Is it common for an Intensivist to bill a Consult? If so, then I need to educate the intensivists on improving their documentation so as to support the requirements for a Consult. (Of course, the requesting physician is also expected to document the request [and reason] for the Consult.)

    Question 2: In cases where the post-op care is not a Consult, should the Intensivist bill Initial or Subsequent Care? Especially in the case of the pediatric critical care codes, there is a significant difference in reimbursement between Initial and Subsequent Care.

    I've done quite a bit of research regarding the above, and yet I'm still not entirely confident about my findings.

    Thanks in advance for your assistance!
    Nancy, CPC, CPC-H

  2. #2
    Milwaukee WI
    Default Why isn't he billing critical care?
    So the patient is in the ICU but isn't critically ill?

    I'm guessing your intensivist thinks s/he should code the consult AND critical care. This is incorrect.

    If the patient is critically ill, and the physician is providing critical care, then the critical care codes should be used. If the patient is NOT critically ill but requires intensive monitoring you COULD use a consultation code, or a subsequent hospital visit code, depending on how the request for care was worded. If the patient is a neonate you can use the NICU codes for a patient requiring intensive monitoring, who is not critically ill (usually low weight).

    If you are using the pediatric or neonatal intensive care codes you would use INITIAL if it is the first day the child is receiving intensive care. Otherwise, you would use subsequent.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. Red face Post-Op Patient in PICU

    Thanks for your prompt reply! I appreciate it!

    In answer to your question, the patient could be critically ill (post-op heart patient) or not (some post-op neurosurgery patients). The doctors are only charging one charge on a particular day.

    So it looks like the rules are:
    1> Intensivist should charge Initial (not Subsequent) Critical Care for a post-op patient in critical condition.
    2> Intensivist could charge Initial Hospital Care or an Inpatient Consult (the latter if the surgeon is requesting advice, recommendations, etc) for a patient not in critical condition.

    Tessa, how does the following fit into all of this? This is what is confusing me regarding the use of Initial versus Subsequent codes. It's from the Medicare Claims Processing Manual, Chapter 12, 30.6.10.I.

    "Surgeon's Request That Another Physician Participate in Postoperative Care. If the surgeon asks a physician . . . who had not seen the patient for a preoperative consultation to take responsibility for the management of an aspect of the patient's condition during the postoperative period, . . . the physician['s] . . . services would constitute concurrent care and should be billed using the appropriate subsequent hospital care codes in the hospital setting . . . "

    Thanks for sharing your knowledge and insights.
    Nancy, CPC, CPC-H

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