This coding challenge was first posted on Wednesday, January 11, 2012.
Mrs. Smith, an 82-year-old African American female, presented to the emergency department by ambulance after falling on some ice.
She was found to have a femoral neck fracture and was admitted to the hospital under the care of the hospital medicine service. Orthopedic surgery was performed without complication on hospital day #2. Her past medical history is significant only for systemic hypertension, which is well controlled on hydrochlorothiazide.
Mrs. Smith’s post-operative course was unremarkable until hospital day #4 when palpitations woke her from sleep at 3 a.m. An electrocardiogram demonstrated atrial fibrillation with rapid ventricular response. The nocturnist saw the patient, placed her on continuous telemetry and instituted appropriate medical therapies for her condition.
Her usual hospitalist saw her later in the morning. Although atrial fibrillation persists, her rate is now controlled.
The Challenge: How would you bill and why?
- 1. Each physician submits separate charges for the work he or she did
- 2. Only the nocturnist submits charges since he was the first physician to see the patient on day of service
- 3. Only her usual hospitalist submits charges since she was the last physician to see the patient on day of service
- 4. The physicians consolidate their work into a single charge for day for service
These physicians are partners (i.e., both in the same group), and both providers submit charges under the same tax ID number.
More than 40 votes were cast but only 7 people answered correctly with option #4: “The physicians consolidate their work into a single charge for day for service.”
Here’s why: At age 82, Mrs. Smith is a Medicare beneficiary. Chapter 12, Section 30.6.5 of the CMS Internet-Only Claims Processing Manual indicates that Medicare views physicians who are in the same group and of the same specialty as a single physician.
The nocturnist and hospitalist both saw Mrs. Smith on the same calendar day and for the same problem (new onset of atrial fibrillation). The level of the subsequent hospital visit CPT code (based on the key components of history, exam and medical decision making) should be selected based on the combined documentation from both physicians’ visits.
The visit by the orthopedic surgeon is billed as a post-operative visit (99024) which is included in the global surgery payment. Thanks for all of your submissions!
THIS CODING CHALLENGE AND ALL COMMENTS ARE POSTED FOR DISCUSSION PURPOSES ONLY AND DO NOT REPRESENT CODING ADVICE. FOR SPECIFIC CODING ADVICE, CONSULT A PROFESSIONAL CODING AND BILLING EXPERT. ALL INFORMATION HEREIN IS PROVIDED WITHOUT WARRANTY OF ANY KIND.