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Inpatient admission,not enough HPI bullets

  1. Default Inpatient admission,not enough HPI bullets
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    Hospital Inpatient admissions have only detailed or comprehensive for history level.If there are not enough bullets in the HPI to qualify for an extended HPI, which you need to have for a detailed history. The scenario I have is a patient seen in the ER and then admitted. Would I use the lowest level 99221,even though this level requires a detailed history ? Any input or references is appreciated. Thank you
    Thank you
    S

  2. #2
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    No you cannot default to the 99221 if you have not met the criteria. Was your physician the one that saw the patient in the ER prior to admission? If so then use the documentation for the ER visit as well as the admit note... If not then I would query the physician for more information, if the patient is not ill enough for the provider to get the information needed for the initial visit level then perhaps it should have been and observation stay.

    Debra A. Mitchell, MSPH, CPC-H

  3. Default Thank you
    That's what I thought. I am only one point short of an extended so I am digging. The pt's cc is urinary hesitiancy, hesitancy would be considered AS/S or Quality ? I have been out of the e&m coding loop for quite sometime so please excuse my ignorance. Thank you
    Thank you
    S

  4. #4
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    can be can quality as long you are not double dipping did you get as many its for pfsh and row

  5. #5
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    I was under the impression that ever since consult codes were eliminated by medicare it was feasible to use subsequent codes if not enough bullets were obtained to meet the critieria for initial codes. That being said could he have not used 99231 or 99232?
    Last edited by Tonyj; 10-10-2011 at 02:00 PM.

  6. #6
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    Quote Originally Posted by Tonyj View Post
    I was under the impression that ever since consult codes were eliminated by medicare it was feasible to use subsequent codes if not enough bullets were obtained to meet the critieria for initial codes. That being said could he have not used 99231 or 99232?
    That applies to the consultant not to the admitting provider.

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
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    Quote Originally Posted by mitchellde View Post
    That applies to the consultant not to the admitting provider.
    Thanks much, I realized that after reading several other threads.

  8. #8
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    Quote Originally Posted by mitchellde View Post
    That applies to the consultant not to the admitting provider.
    Our local MAC (WPS) allows us to bill a subsequent inpatient code if the documentation does not meet the requirements for an initial visit. They do not specify that this is for "consultants" only.

    "Question 7: I am the admitting physician for the patient and today is the first day I see the patient. However, my documentation does not support the level of service for a 99221. Should I bill an NOC code or code to a subsequent care code?
    Answer: If your level of documentation does not support the procedure code 99211, CMS has instructed contractors to not find fault with a provider using a subsequent care procedure code. The use of the NOC 99499 should be very rare. "

    However, I will say that this should be a uncommon practice, as the documentation should be there! I would be afraid to submit too many of these and raise a red flag.
    Linda Vargas, CPC, CPCO, CPMA, CPC-I, CEMC,CCC
    PMCC Licensed Instructor
    Kansas City, MO Chapter
    President, 2018
    Vice President, 2017
    Member Development Officer 2016
    Harrisonville, MO Chapter President - 2013
    ICD-10 Education Coordinator- 2012
    Chapter President - 2011
    President Elect - 2010

  9. #9
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    Quote Originally Posted by Coder2hear View Post
    Hospital Inpatient admissions have only detailed or comprehensive for history level.If there are not enough bullets in the HPI to qualify for an extended HPI, which you need to have for a detailed history. The scenario I have is a patient seen in the ER and then admitted. Would I use the lowest level 99221,even though this level requires a detailed history ? Any input or references is appreciated. Thank you
    "In situations where the minimum key component work and/or medical necessity requirements for initial hospital care services are not met, subsequent hospital care CPT codes (99231 and 99232) could potentially meet requirements to be reported for an E/M service that could be described by CPT consultation code 99251 or 99252. Contractors shall expect changes to physician billing practices accordingly. Medicare contractors shall not find fault with providers who report a subsequent hospital care code (99231 and 99232) in cases where the medical record appropriately demonstrates that the work and medical necessity requirements are met for reporting a subsequent hospital care code (under the level selected), even though the reported code is for the provider's first E/M service to the inpatient during the hospital stay."

    https://www.cms.gov/transmittals/downloads/R147BP.pdf

    Palmetto GBA...

    Jurisdiction 11 Part B
    Can I submit a subsequent hospital CPT code if my documentation does not support one of the three levels of initial hospital services?

    Answer:
    Yes. Submit services that do not meet the minimal documentation requirements for the initial hospital service (CPT codes 99221-99223) as subsequent hospital visits (99231-99233). In all situations, submit the evaluation and management (E/M) code that represents where the visit occurred and that identifies the complexity of the visit performed.


    last updated on 10/04/2011
    Last edited by RebeccaWoodward*; 10-12-2011 at 01:15 PM.

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