Code Help

[J ROD]

What is the easiest way to determine whether to bill 99231 or 99232. I know 99233 is rare and only for really complex patients.

Also what codes do you use for a new evaluation? inpatient, ED, C/L. Where I came from in residency, we did 90792 for all of them. New place uses 99221 etc for new inpatient and 99251 etc for consult new. How do I determine best what level? I want to bill where I get the credit I deserve and not underbill as I am new to this. Thanks.

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[nexus73]

99231-99233 is easy if you base on time. I find 99233 is not that rare depending on the patient and their needs that day, or if I’m also on the floor making calls to family or talking to medical consultant or psych pharmacist or if there are a lot of records to review—easy to hit 35 minutes total. If you lookup the AACAP e/m quick reference it is a good guide for billing based on complexity.

New evaluation typically 99221-99223 for admissions and consults in my hospital. If observation status will use either 90792 or outpatient 99203-99205 new patient eval code for consult. Never used 99251.

 

[NickNaylor]

Our institution uses the inpatient consult codes (I forget when they are off-hand) for initial assessments and the subsequent hospital care codes for follow-ups. Unless you're following up a patient that probably doesn't need to be seen in the first place, I would imagine that you should be able to bill a level 2 subsequent care visit on pretty much every encounter. I bill level 3 if there is something acute going on, a patient is agitated, or significant changes in pharmacotherapy are being recommended.

I do not get dragged down in the details of billing. Our documentation is set up so that everything included in the note is sufficient to bill the most complex visit available in terms of history elements, so I very grossly bill based on medical complexity since everything else is taken care of. My experience has been that there is relatively wide flexibility in determining medical complexity, assuming you aren't going totally off the rails. I have yet to earn the ire of our billing department with this approach. For me, choosing 99231 vs. 99232 vs. 99233 literally consists of "hm, this seems like a level 3, let's go with that," and I'm done.