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Billing when patient unable to complete the initial appointment

  1. Default Billing when patient unable to complete the initial appointment
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    Does anyone know what the correct way to bill for the following scenerio?

    A patient was brought back to a room and the intake was done by a medical assistant, the cast applied from the emergency room was removed, and we took x-rays of the patients hand. While the patient was in the exam room waiting to see the physician he had a seizure. We called 911 and the patient was taken to the hospital by ambulance. There was not a diagnosis determined and the patient was not given any type of treatment options. We were unable to do a complete exam but is there a way we can still bill for the procedures that were done on that date of service? Or, is it ok to bill for all of the charges on the date that the patient came back for the complete examination?

    Thank you in advance for your responses.

  2. #2
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    Quote Originally Posted by savannah@katranjihandcenter.com View Post
    Does anyone know what the correct way to bill for the following scenerio?

    A patient was brought back to a room and the intake was done by a medical assistant, the cast applied from the emergency room was removed, and we took x-rays of the patients hand. While the patient was in the exam room waiting to see the physician he had a seizure. We called 911 and the patient was taken to the hospital by ambulance. There was not a diagnosis determined and the patient was not given any type of treatment options. We were unable to do a complete exam but is there a way we can still bill for the procedures that were done on that date of service? Or, is it ok to bill for all of the charges on the date that the patient came back for the complete examination?

    Thank you in advance for your responses.
    I'd bill what you managed to get done (cast removal, x-rays) for sure - the E/M would depend on a couple of factors; first, did the physician intervene in any way when he had the seizure? (Was he by the patient's side?) You may be able to bill up to a 99215, if it was documented properly. Documentation guidelines state that "If the physician is unable to obtain a history from the patient or any other source the records should describe the condition or other circumstance which precludes obtaining history." This situation would be credited as though a comprehensive Hx was taken. If the nurse intake included vitals, you have a portion of the exam documented, and between the management options/data reviewed for the encounter (cast removal, x-rays, emergency intervention for the seizure, the decision to admit the patient to the hospital by calling 911), and the high risk of an abrupt change in neurological status, there should be enough there to constitute high MDM.

    If the physician never saw the patient at all, however, you shouldn't bill anything higher than a 99211 for the nurse checking vitals.

    See also CPT codes 99058 and 99060 - they may be applicable, too, depending on what your notes say. Hope that helps!

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