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Sharing Call With A Hospitalist

Jessica Posted Wed 29th of October, 2014 10:25:30 AM

We are a group of 5 neurologists and 2 nurse practitioners. We have hospital privileges at the local hospital where we provide consultation services. The hospital just recently hired a neuro-hospitalist. She is an employee of the hospital, not a locum tenen. We have no business partnership with the hospitalist. We will now be sharing call on a one week on/one week off rotation with the hospitalist.

My doctors question how they may bill THEIR first encounter with a patient when they provide hospital services for the first time - the scenario being that the hospitalist did the initial consultation and perhaps some follow up, then we took over the care when it was our week to be on call. My doctor's point of view is that the patient would be new to our practice, justifying a 99222 or a new patient E&M code when billing Medicare. However, my concern is that 99222 requires a comprehensive history, comprehensive exam, and moderate decision making. I am concerned that Medicare would question medical necessity of a comprehensive history, etc. when the patient had a recent "work up" by another neurologist during the same hospital stay. I am also nervous about using new patient E&M codes as I'm not certain that there is not an unspoken association with the neuro-hosptialist that limits us to follow up codes only, i.e. 99232, 99233, etc. My doctors, of course, have access to the neuro-hospitalists notes from the initial consultation in this scenario. This scenario refers to patients deemed "admission", not short stay.

I'd appreciate any guidance you can provide. Thank you.

SuperCoder Answered Thu 30th of October, 2014 07:07:54 AM

Thank you for your question.

We are currently looking into this and will provide a response promptly.

SuperCoder Answered Thu 30th of October, 2014 07:07:54 AM
Thank you for your question. We are currently looking into this and will provide a response promptly.
SuperCoder Answered Thu 30th of October, 2014 07:31:21 AM

Thank you again for your question.

In this case your doctors would be billing a subsequent visit. The doctors are on call with the hospital, providing follow up services to the neuro-hospitalist, even though it is the first time that doctor saw the patient. Unless your doctors are being called in for a consultation, or second opinion consultation, they are acting as a follow up to the hospitalist specialty that already completed the initial visit.

Jessica Posted Thu 30th of October, 2014 09:41:59 AM

Thank you for your response. I will share this with my providers.

SuperCoder Answered Thu 30th of October, 2014 10:22:16 AM

You are welcome.

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