E/M question on guidelines
Good Morning everyone
This scenario is for Medicare patients in an inpatient hospital setting:
I have a physician that seems to think that if he sees a patient in the hospital in the last 3 years, that he can only bill for a subsequent visit 99231-99233. I know about the 3 year rule on a new/est patient in the office setting, never heard of this applying to a patient in an inpatient setting. I have been taught that if the patient is admitted for a new complication that we have not seen the patient for, and we are consulted by the admitted physician, it is billed with the 99221-99223 codes without the "AI" modifier. I have tried to explain to the physician that if the patient is established and its an admission for an issue that is known, then we would bill the 99231-99233. Am I understanding this right? I've tried to find documentation on Medicare's website about this kind of scenario and I'm having a hard time. If anyone can send me a link that may help so I can show my doctor the correct way to bill these that would be great.
Jammie Barsamian, CPC, CCC, CEMC, CCS-P, CPMA