Coding question: Inpatient Prolonged services

[jm192]

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I'm hoping someone here is familiar enough with it to answer this. Sorry if this isn't the right place.

As a hospitalist, it's often that a nocturnist admits the patient after midnight, and bills an H&P code. Then I spend a lot of time during the day addressing things that have come up. I've learned about 99358--since we're in the same service--is it ok to use 99358--or does it have to be the same physician?

 

[chessknt]

I'm hoping someone here is familiar enough with it to answer this. Sorry if this isn't the right place.

As a hospitalist, it's often that a nocturnist admits the patient after midnight, and bills an H&P code. Then I spend a lot of time during the day addressing things that have come up. I've learned about 99358--since we're in the same service--is it ok to use 99358--or does it have to be the same physician?

My understanding is that you are viewed as the same provider as long as you are under the same taxonomy (which you would be).

I think you are thinking of the wrong code since that one is a non-face to face time code that is not an add on and is not allowed at the same time as an E/M code (The 5 Point Checklist for CPT Codes 99358 and 99359). I think you may be thinking of 99356 which is the standard prolonged inpatient face to face service time code. In order to bill this however the original provider needs to be billing by time and document that time (eg 70 minutes face to face admitting a level 3) then you need to document you spent (at least) 30 minutes additional face to face caring for that person in order to justify the charge (assuming they billed at the top of the charge, if they billed as a level 3 but only document 30 minutes spent then you have to spend 40 to get to 70, then an additional 30 all face to face of course). As you can imagine it is a bit hard to justify most of the time. You can contort yourself every which way to document that you spent 2 hours in a patients room to get an extra 4 wrvu meanwhile ortho did a knee in the same time period and got 45 wrvu or just accept your fate and move on.

It is some bull**** of the highest order that inpatient E/M billing places a value of exactly $0 for work you do on the same day as an admit (or cross-covering) unless it is spent in the patient's room, arguably the place in the hospital where you accomplish the least as an IM physician. Even after these amazing EM billing changes CMS conjured up this still hasn't been addressed but thems the breaks... Thank you for your charity service you hero!

 

[jm192]

My understanding is that you are viewed as the same provider as long as you are under the same taxonomy (which you would be).

I think you are thinking of the wrong code since that one is a non-face to face time code that is not an add on and is not allowed at the same time as an E/M code (The 5 Point Checklist for CPT Codes 99358 and 99359). I think you may be thinking of 99356 which is the standard prolonged inpatient face to face service time code. In order to bill this however the original provider needs to be billing by time and document that time (eg 70 minutes face to face admitting a level 3) then you need to document you spent (at least) 30 minutes additional face to face caring for that person in order to justify the charge (assuming they billed at the top of the charge, if they billed as a level 3 but only document 30 minutes spent then you have to spend 40 to get to 70, then an additional 30 all face to face of course). As you can imagine it is a bit hard to justify most of the time. You can contort yourself every which way to document that you spent 2 hours in a patients room to get an extra 4 wrvu meanwhile ortho did a knee in the same time period and got 45 wrvu or just accept your fate and move on.

It is some bull**** of the highest order that inpatient E/M billing places a value of exactly $0 for work you do on the same day as an admit (or cross-covering) unless it is spent in the patient's room, arguably the place in the hospital where you accomplish the least as an IM physician. Even after these amazing EM billing changes CMS conjured up this still hasn't been addressed but thems the breaks... Thank you for your charity service you hero!

Thanks for your response.

I virtually never spend 30 minutes face to face with a patient that came in early that same morning/overnight, and they certainly don't document the time spent. Maybe once a year I'll qualify for 99356.

99358 I thought could be used in conjunction with another CPT code if you spent enough time reviewing records, adjusting treatment plan, etc. A lot of times, I'll spend 5-10 minutes in the room. And then a lot of time in front of a computer reviewing records, H&P,, ER notes, labs, imaging, speaking to other physicians, family, etc. My understand of it's use was that it must occur before or after another E/M service or companion service. Is that inaccurate in regards to the use of 99358?

Edit: I certainly wouldn't lobby for anyone to do this on every after midnight admission. But there are definitely times where new info is present or new things happen and you spend a lot of time non f2f changing and reviewing things.

 

[chessknt]

Thanks for your response.

I virtually never spend 30 minutes face to face with a patient that came in early that same morning/overnight, and they certainly don't document the time spent. Maybe once a year I'll qualify for 99356.

99358 I thought could be used in conjunction with another CPT code if you spent enough time reviewing records, adjusting treatment plan, etc. A lot of times, I'll spend 5-10 minutes in the room. And then a lot of time in front of a computer reviewing records, H&P,, ER notes, labs, imaging, speaking to other physicians, family, etc. My understand of it's use was that it must occur before or after another E/M service or companion service. Is that inaccurate in regards to the use of 99358?

Edit: I certainly wouldn't lobby for anyone to do this on every after midnight admission. But there are definitely times where new info is present or new things happen and you spend a lot of time non f2f changing and reviewing things.

My understanding is that it has to be 'extraordinary' so if you started billing it all the time it might raise flags.