Avoid Hospital Admission Coding Errors When Billing For Absent Internists

There are two arrangements absent internists can make with other providers to get paid for inpatient services on-call billing and reciprocal billing. On-call billing refers to the coverage arrangements internists make within a group practice using a common tax identification number. Reciprocal billing refers to an agreement made with other internists with different tax identification numbers.

One billing dilemma faced by internists within a group practice occurs when two internists provide separate services to the same patient on the same day. For example, an on-call physician admits one of his or her colleagues patients to the hospital after midnight. Then the patients regular physician makes rounds on the patient later that morning. Because most carriers deny reimbursement for two E/M services for the same patient on the same day, the second visit is often provided for free.

According to Michael Haynes, MD, FACP, an internist and pulmonologist who is also the compliance director at University Medical Associates in Augusta, Ga., the only way the patients physician can bill for the second E/M visit is to code it as critical care [99291-99292].

Critical care, as defined by CPT, allows that other E/M services may be provided to the same patient on the same date by the same physician.

However, situations that permit upcoding to critical care are infrequent for internal medicine practices. If its not a life-threatening situation and it remains an elective visit, even if the regular doctor is doing things that he might be doing in critical care such as adjusting a ventilator or changing a drip, the second visit cant be billed, Haynes says.

How to Coordinate Same-day E/M Services

Theres only one clear-cut solution to the dilemma, says Jim Stephenson, president of North Central Medical Management in Elyria, Ohio, who understands the frustration experienced by Haynes. The best option for both internists in an on-call arrangement is to coordinate same-day services and bill them under one E/M service.

Technically, what should happen is either the covering physician bill the overnight admit [e.g., 99221, initial hospital care, per day, for the evaluation and management of a patient which requires a detailed or comprehensive history and examination and medical decision making that is straightforward or of low complexity], or the regular physician, who did morning rounds, bill a higher-level E/M admit [99222 or 99223]. The second visit should include either a comprehensive or detailed history, exam and medical [...]

- Published on 2001-06-01