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Billing Codes and Pearls
In an effort to support clinical income, the Revenue Cycle Management Committee has developed a new reference tool with answers to common coding and/or billing questions.
Updates will be distributed routinely by email with Billing/Coding questions and answers. Our goal is to provide clear and practical solutions to frequently asked questions. These emails will provide links to this page where the same questions and answers will be readily available as a reference tool. If you have questions about the content of these updates, please feel free to contact either Margaret Henry or Kempa Carriere-Arnold .
QUESTION 1: Is any billing permitted if a patient is seen overnight by an attending physician when the patient has been seen earlier in the day by another attending physician on the same service?
If the patient is seen after 12 midnight, the visit would be considered "subsequent hospital care” for the "next" day. Only one subsequent care service can be billed per day (24 hours) by the same specialty. Per AMA/CPT-4, 2004, p.12, subsequent hospital care services are "per day".
Physicians in the same group practice but who are in different specialties may bill and be paid without regard to their membership in the same group. (5.5.04)
QUESTION 2: If one of our docs at Bayview is working in the chronic vent unit and works on a patient who has become critically ill, can she/he bill for critical care services? I know that docs can bill for critical care services in non-ICU parts of a hospital (e.g. the E.D.). But since the chronic vent unit is not part of the hospital, I am not sure if critical care billing would be accepted.
Critical care can be billed in any place of service, including chronic vent units. The only stipulation would be that the documentation supports the utilization of critical care codes (i.e. patient condition). (5.5.04)
BILLING/CODING PEARLS ARCHIVE
These Billing/Coding pearls are archived by relevancy to Division; please select the appropriate link below:
- Allergy & Clinical Immunology
- Gastroenterology & Hepatology
- General Internal Medicine
- Infectious Diseases
- Occupational & Environmental Medicine
- Pulmonary & Critical Care Medicine
These responses represent the Revenue Cycle Committee’s best advice to clinical faculty and providers upon the questions posed. It includes input from the Office of Billing Quality Assurance. If you believe you have extenuating circumstances or that a more in-depth discussion with your division is indicated, please notify Margaret Henry (firstname.lastname@example.org, 5-1629) or Kempa Carriere-Arnold (email@example.com, 0-8398).