Lately, there had been a lot of questions about the proper use of discharge day management. The discharge day management codes include all care by the physician who is reporting that code on the discharge date. So if he sees the patient in the morning and then comes in at noon and discharges her and follows up talking about what's going to go on and then leaves the floor and comes back with prescriptions, et cetera, all of this work is included as part of discharge day management. And all of it needs to be documented in the chart along with the total time that was spent with the patient in this activity.
Another important point to note is that if you have a physician who is providing concurrent care on that date of discharge, they don’t bill discharge day management. Instead, they will be billing subsequent inpatient services. And the payer will know of the difference because one will be billing subsequent care and the other discharge day management, whether or not you're going to get paid for both, that's another matter to be interpreted.
Brand New Codes
Now, we all know we have codes in the book for telephone consults. Those are the ones that are initiated by the patient to the physician within the seven day period and that kind of thing. We also have case management codes where the physician is coordinating care, etc. But one of the frequently asked questions is, “Well, my doctor spent a lot of time on the phone with another doctor coordinating care and doing things like that. How do we get paid for this?” And up until now, there was no very good way to get paid for this other than the face-to-face encounter where coordination of care was going on with the patient present.
In these interpersonal telephone consultations, the patient is not present. And while the payers are not going to pay any attention to this at all because they aren't there, these in fact are valuable services that physicians provide to each other under consultation category. However, if it's branded as a consult, Medicare will not be paying for any of these because by law, they can only pay for services where the patient is actually present with some very few exceptions to that rule basically under case management. So these probably will not apply to them. Or at least the meeting, the Medicare directors who were there indicated they probably are not going to cover these codes.
There are some opportunities to use them probably not too frequently in Ob-Gyn but there may be some instances. Each of the codes is marked by a time period, 5 to 10 minutes, 11 to 20, 21 to 30, and 31 minutes or more. This means that a physician who is taking care of the patient calls in – not calls in but calls up or emails or something on the internet the consulting – what they call the consulting physician who has more expertise.
And then a lot of work occurs and we get the care that's going to be advised by the consultant and the primary care goes on and does what has been recommended. Okay. So first of all, what is it? It's a non face-to-face assessment and a management service. And it has to be by a physician with a specific specialty expertise. So this is not the case where you're going to have two physicians in the office consulting each other and they're both in the same specialty. This has to be something entirely different than that.
Usually, these kinds of service are going to be provided when it's very complex or very urgent situation because face-to-face with the physician who is consulting is not possible at all, either because they are too far away, the person who has the expertise is in the OR and doing over the speakerphone, that kind of a thing, but no face-to-face is possible at the time this consultative help is required by the physician who's taking care of the patient.
So, the person who reports these codes is the one who's been asked for their opinion or advice. But you can't bill if he has had a face-to-face encounter with the patient within the last 14 days. And you cannot – you can use these codes only if you've not accepted transfer immediately over the phone.
So an example would be the patient is in the ER and is bleeding. The ER physician calls an Ob-Gyn and says, “I have this patient hemorrhaging and having severe abdominal pain. It might be an ectopic. Can you get down here and take care of this for me?” “Yes, I'll be right there.” That physician then takes over the care. At that point, there's no interpersonal or inter-professional telephone consultation going on because it was an immediate transfer of care.
But if the same situation with the possible ectopic and the Ob physician says, “Well, let me take…” – and this happens to be, his patient happens to say, “Well, let me take a look at a record.” “Well, no, she can't be an ectopic because she was just in here four days ago and we did a pregnancy test on her because we just put in an IUD.”
So the pelvic pain could possibly be the other thing. And the doctor says, “Well, okay, I will – now, given that information, I will do that. What would you recommend?” And the Ob says, “Well, if it were me, I would go ahead and do an ultrasound real quick and see if the IUD is out of place, see if there's a rupture there, blah, blah, blah” and fills all it in the blanks and – “But I'm not coming down to see the patient and I'm not taking over her care.” That would be an example that might work in that case.
You need to understand that this means physician only. So a qualified non-physician practitioner could not be using these codes at all. It will never be considered as a consultant for purposes of billing these codes. So the patient can be they're being new to the consultant or an established patient. Now, if she's established patient, it means it's usually a new problem. But sometimes it can be an existing problem that has gotten terribly worst. And again, the physician has not seen the patient. The consultant has not seen the patient within 14 and is not in the position to come see the patient right now regarding this problem.