1. Will Medicare make payment for more than one initial hospital visit during the same admission performed by providers of the same specialty but different group practices?
No, Medicare does not reimburse multiple visits to providers of the same specialty within the same and/or different group practices. Medicare will reimburse multiple visits to physicians from different groups and different specialties, or physicians of different specialties within the same group practice.
2. If we decide to admit from the office, should we bill the office visit and the lowest initial admission code?
The basic requirements for the initial hospital admission codes have not changed, so a face-to-face visit at the hospital is still required. If admitting the patient after an office visit, the initial hospital code would include all work performed by the physician in all sites – office and hospital.
3. Will Medicare pay for more than one initial hospital visit per hospital admission?
In the inpatient hospital setting and nursing facility setting, any physician and/or qualified NPP who performs an initial evaluation may bill an initial hospital care visit code (CPT code 99221 – 99223) or nursing facility care visit code (CPT 99304 – 99306), where appropriate.
4. Am I permitted to bill an initial hospital visit (for a consultation) even though I have an established relationship with the patient?
Yes. The concept of a new or established patient does not apply to initial hospital visits since these codes are used for hospital inpatients. Practitioners can use these codes for the first visit to an inpatient even if they have an established relationship with the patient.
1. Is it a requirement to document the past, family, and social history (PFSH) for subsequent in-hospital visits?
For the categories of subsequent hospital care and subsequent nursing facility care, the current procedural terminology requires only an “interval” history. It is not necessary to record information about the PFSH.
Discharge Day Management
1. How do I bill discharge day management when I discharged my patient on day one, but dictated my notes on day 2? Which day do I use for submitting the claim?
Bill the discharge day management with the actual discharge date. The medical records should clearly state the date of the actual discharge and dictated the following date.
2. How do you bill for a patient who expired?
According to established legal principles, an individual is not deceased until there has been official pronouncement of death. Therefore, an individual expired at the time of pronounced of death by a legally authorized person who is usually a physician. Reasonable and necessary medical services rendered up to and including pronouncement of death by a physician are covered diagnostic or therapeutic services.
Centers for Medicare and Medicaid Services (CMS) Publication 100-03, National Coverage Determinations, Chapter 1, Part 1, Section 70.4
Services may be reduced when the medical records do not contain the time the physician spent with the patient. Hospital discharge day management codes 99238 (30 minutes or less) and 99239 (more than 30 minutes) are time based so it is imperative that medical documentation reflect total time spent by a physician during the discharge of a patient. The codes include, as appropriate, final examination of the patient, discussion of the hospital stay, (even if the time spent by the physician on that date is not continuous), instructions for continuing care to all relevant caregivers, and preparation of discharge records, prescriptions and referral forms.
Rather than obtaining copies of pages from the hospital record, is it sufficient to send a statement that I spent more than 30 minutes in my discharge activities, as long as I give the specifics regarding patient name, health insurance claim number, and date of service?
While this information is necessary when billing 99239, it is essential to send the visit note or discharge summary from that date of service, in order to substantiate the service billed.