Essentials of On-Target Subsequent Hospital Care Coding

Are you losing money by frequently reporting the lowest code for subsequent hospital care services? Learn 5 quick ways to increase your facility’s bottom-line.

                       

You may be reporting the lowest code for subsequent hospital care services from physicians such as hospitalists; however it doesn’t mean that it’s right to do so. The care level for most hospital stays changes and this could derail your coding if you do not watch your steps.

Here are some pointers on how to know when you are using 99231 more frequently and how to consult the physician’s report to rectify the coding.

Keep a tab on your use of 99231

Many specialists use 99231 more than any other subsequent hospital care code. That code is right in most cases; however, if you use 99231 for all your subsequent hospital care services, you may invite more trouble than anticipated. 

What does reporting 99231 mean?

This means that either most subsequent hospital visits are low-level services or physicians regularly under code for inpatient care. But all hospital visits are not low-level; therefore you should also be reporting higher-level subsequent hospital care – but only if your documentation merits it.

When problem arises: Since most payers normally bundle hospital care into postsurgical visits, many physicians are not well-versed with the documentation guidelines associated with subsequent hospital care for non-surgical situations.  Use 99231-99233 if you take up the patient’s care after another physician admits the patient to the hospital.

Five steps you can take to ensure you are using subsequent hospital care codes correctly are:

·         Learn the coding levels: Teach your clinicians about what CMS and CPT® require for each level of care.

·         Warn physicians of red flags: If your physician reports 99231 for all subsequent hospital care services, this could raise red flags with payers. Using this code will not save you from a government audit, as is normally believed. 

·         Focus on MDM: According to CPT®, of the three E/M components – history, exam and medical decision making – you need to document only two to use one of the subsequent care codes.

·         Include additional observations: While documenting subsequent hospital care, experts advice that providers should include additional observations such as whether the patient’s condition is stable, is the condition improving or worsening, and has any new problem developed.

·         Perform a chart review: Carry out a chart review if your facility reports the same code over and over again. Take a random chart sampling where you used 99231. Determine the history, exam and MDM levels on each file to figure out whether it meets the 99232 or 99233 requirements.

Overusing lowest level codes for subsequent hospital care could raise red flags for payers. Following the above tips will however take the headaches out of your subsequent hospital care coding to a great extent. For additional help, refer to SuperCoder Inpatient Facility Coding & Compliance Alert.