Inpatient billing codes

[doctordoctor99]

Hi all--at my practice, we tend to get a large number of inpatient consults. A number of times I will go see the patient a few times after their initial consult to assess any changes in their clinical status before treatment, or re-discuss treatment.

Does anybody have any experience billing CPT codes 99231-99233 (subsequent inpatient hospital care) in this setting? My understanding is that once the patient starts treatment, these can no longer be billed and are wrapped up in the OTV charges, but can't get any clarity on visits before that.

The reimbursement isn't much, but it would be great to get something for my time.

Thanks all--

---

Members don't see this ad.

 

[medgator]

Only bill the initial 221-223 codes myself as i picked rad onc to not round, but my understanding is that you should be good billing them if the pt is admitted regardless of tx status

 

[BobbyHeenan]

This sounds like my practice.

I bill those 99231-99233 codes all the time. Obviously, you need to do a note and document you rounded on the patient, but yes I too often spend time on cases well before their CT sim and that needs to be billed.

Once the patient has a CT sim/complex treatment plan charged then all "rounding" type of notes are bundled into OTV from what I understand. Work done before that should be billed though.

 

[Tigerstang]

Hi all--at my practice, we tend to get a large number of inpatient consults. A number of times I will go see the patient a few times after their initial consult to assess any changes in their clinical status before treatment, or re-discuss treatment.

Does anybody have any experience billing CPT codes 99231-99233 (subsequent inpatient hospital care) in this setting? My understanding is that once the patient starts treatment, these can no longer be billed and are wrapped up in the OTV charges, but can't get any clarity on visits before that.

The reimbursement isn't much, but it would be great to get something for my time.

Thanks all--

I have billed this regularly in a previous practice where I kept a relatively large inpatient service. Non issue, but you are correct you cannot bill once under treatment, even if on treatment break. But absolutely should bill if you consult and help with inpatient workup, which I do regularly.

 

[doctordoctor99]

Thanks all--agreed--not trying to round, but would be great to get reimbursed if the situation calls for it...

 

[StealthTech]

Bumping this old thread.

My hospital prefers to only offer complex isodose on inpatients because we don't get paid for anything? Is this really true? We always hear about things being bundled under the hospital. Drg, but does this really mean when we're not getting paid for any of our work?

I'd much prefer to give imrt or SRS or sbrt in certain situations warranting it.

 

[radiaterMike]

I think this probably varies by hospital/institution - you should get the wRVUs for inpatient care, but the hospital only gets paid a set amount based on the DRG. So I assume they dont want you billing more complex cases since your billing then cuts more into the 'pie' of what is reimbursed to others. If your pay is wRVU based then you essentially get credit for what you do. I can see the logic about not wanting SRS or SBRT for inpatients. ASTRO's model policies and most insurers require a good performance status. If someone 'needs' that treatment in the hospital then arguably their performance status would not fulfill that. But we all know that for some patients, KPS is unrelated to what we treat, and can be expected to improve in others. In some patients, transportation back and forth for treatment can be prohibitive. More knowledgeable people may know how some of the alternative payment models in Rad Onc would have impacted this billing.

 

[medgator]

Only true for straight Medicare pts I believe. Commercials will pay. Not sure about MCR advantage

 

[StealthTech]

Only true for straight Medicare pts I believe. Commercials will pay. Not sure about MCR advantage

Do you have more information about this? I want to be able to have some sources for our admins.

 

[medgator]

Do you have more information about this? I want to be able to have some sources for our admins.

I don't except to say that DRG fixed payments to hospitals for all services is something unique to Medicare and is not followed by commercial insurances when a patient is admitted to a hospital

 

[evilbooyaa]

Bumping this old thread.

My hospital prefers to only offer complex isodose on inpatients because we don't get paid for anything? Is this really true? We always hear about things being bundled under the hospital. Drg, but does this really mean when we're not getting paid for any of our work?

I'd much prefer to give imrt or SRS or sbrt in certain situations warranting it.

My understanding (may not be 100% accurate is as follows):
DRG states that for a certain diagnosis, the hospital makes X amoutn of money. I am unclear if it is regardless of length of stay, but this is why every diagnosis for inpatient is so critical, even if it seems non-sensical to physicians.

DRG does not consider whether the patient received radiation or not. Any services billed for radiation on a day the patient is admitted get wrapped into the total DRG compensation, without adjustment. Thus, a HOSPITAL is not gaining anymore money when they treat an inpatient with radiation. However, for a physician on a wRVU and $/RVU contract (not tied to hospital collections), they *should* stlil be getting the RVU credit for the work they did.

You, as a Rad Onc physician, bring enough to the hospital in terms of being responsible for them collecting massive technical fees, that, IMO, they can pay you for the high complexity work you are doing, if you feel it is worth it and in the best interest of the patient. If hospital admin continues to try to tell you that you can't do SBRT, be prepared to either acquiese or be willing to know your worth. Whatever choice you make between those two is situation dependent.

I don't except to say that DRG fixed payments to hospitals for all services is something unique to Medicare and is not followed by commercial insurances when a patient is admitted to a hospital

Is this true? So DRG bundles don't apply to non-classical Medicare patients? I find this hard to believe. Why would commercial insurance NOT follow what Medicare does, especially in a cost-saving space?

 

[medgator]

My understanding (may not be 100% accurate is as follows):
DRG states that for a certain diagnosis, the hospital makes X amoutn of money. I am unclear if it is regardless of length of stay, but this is why every diagnosis for inpatient is so critical, even if it seems non-sensical to physicians.

DRG does not consider whether the patient received radiation or not. Any services billed for radiation on a day the patient is admitted get wrapped into the total DRG compensation, without adjustment. Thus, a HOSPITAL is not gaining anymore money when they treat an inpatient with radiation. However, for a physician on a wRVU and $/RVU contract (not tied to hospital collections), they *should* stlil be getting the RVU credit for the work they did.

You, as a Rad Onc physician, bring enough to the hospital in terms of being responsible for them collecting massive technical fees, that, IMO, they can pay you for the high complexity work you are doing, if you feel it is worth it and in the best interest of the patient. If hospital admin continues to try to tell you that you can't do SBRT, be prepared to either acquiese or be willing to know your worth. Whatever choice you make between those two is situation dependent.


Is this true? So DRG bundles don't apply to non-classical Medicare patients? I find this hard to believe. Why would commercial insurance NOT follow what Medicare does, especially in a cost-saving space?

DRG is a uniquely Medicare thing iirc. Commercials haven't used it?