Pretty much all my H&Ps are 99223’s. There’s just so much work and time spent on the unit for each patient.
My senior colleagues say they bill up to 2/3 99233. I bill quite a bit-probably at least half. As the attending (I’m not a consultant), I am doing a lot of coordination of care-RNs and therapists coming up to me to talk about patients, and I spend a lot of time counseling patient. Calling consultants, etc. I document time carefully (and accurately). I used to dramatically underestimate how much time I spent with patients, and coordinating care.
Team meeting days are always 99233. And I usually spent a lot of time with a patient the second day of admission as well as the day before discharge.
I think you’re probably under billing if you’ve only done two 99233’s... Obviously don’t go trigger happy-it’s fine to Bill more high level visits than others, as long as your documentation supports it. But obviously if you stand out (under-billing can make you stand out as well...) it puts you at risk for an audit.
I bill 99356 modifiers as well (additional 60 minutes) for particularly complicated time-consuming consults, admits, follow-ups, or discharges. It’s not common, but I have one or two every couple weeks. We all end up with patients that sometimes take a couple hours of work in a particular day.
Tobacco cessation (99406 for less than 10 minutes) and advanced care planning (99497 for up to 30 minutes) are good ones to keep in mind as well. You’d be surprised how many full codes want to be DNR and visa versa when you actually sit down and talk with a patient and thoroughly and accurately explain things, not just try to get through things quickly. If we’re going to ask about code status, we may as well do it right and have a real advance care planning talk with the patient. I think only Medicare reimburses for it, but it’s important enough I ask all patients if they’d like to address it.
I unfortunately learned nothing about billing while being a resident. But it’s a good skill to learn, obviously.
Edit: forgive my autocorrect errors. And just to clarify, advance care planning is about more than code status-we talk about POA’s, advance directives, often fill out a POLST, etc.
