Documentation of Discharge Day Management - Part 2

Documentation of Discharge Day ManagementIn a non-face to face situation, unfortunately, most payers will not pay for that at all. There may be a few exceptions to the rule out there. But this way, both the consulting physician and the treating physician may have an opportunity to bill for this additional service that they have provided.

So how do we report the codes? Well, you only report one code, period. And if the consulting physician requires more than one telephone call to complete the service or more than one internet contact as long as it's real time, you accumulate all that time and discussion and you report the final number of total cumulative minutes. But you only report the code once.

Now, the other thing you have to know about this is you cannot report this code unless more than 50% of the time that you're reporting was spent as part of the medical consultative, verbal, internet discussion. In other words, you can't be reviewing the records, “Let me see. I'm reviewing the records, reviewing the records.” It has to be part of the conversation, active conversation that you were having with the treating physician or between the treating physician and the consulting physician. So that is fairly important as well. Now, the example I'm going to give you basically comes out of the CPT coding changes book that we got at the symposium. This is the case of a 57-year old female patient with complaints of epigastric pain. And it's not a CPT scan because there's no such thing. This is one of those cases where the automatic – you misspelled thing in the thing does it wrong.


So they did a CT scan on her and found an incidental finding of a mass on the right ovary. The primary physician contacts the patient’s Ob-Gyn of record to discuss the appropriate evaluation. And the consultant physician, the Ob-Gyn says he spent 20 minutes spent on the consultation. He reviewed the CT scan result. He reviews the patient’s medical record and noted that the patient has a family history of ovarian cancer. So then he talks to the PCP on – this case was probably a telephone conversation – and said, “I want – I think you should order a CA 125. I'd like you to do a follow-up. Go ahead and order a follow-up ultrasound with Doppler to check the mass. And then set-up a consultation with the Gyn oncologist for this patient.”

Then that physician enters the request for the consultation in the medical record. And then a written follow-up report is sent to the treating physician by (Mary’s) doctor. And he outlines his advice and suggestions for longer term care for this patient. So that closes the loop. Now, of the 20 minutes, more than half of this would have to have been spent on the phone advising about the CA scan and ultrasound and the Doppler and why he thought it was important and probably discussion of a specific Gyn oncologist they had in mind, “If you can't get a hold of this one here, there's three others that I would recommend” that kind of a thing.


Now, there were some changes in the surgery section. Some of these changes I'm mentioning because by the off chance that you might be performing them in your offices or might – and particularly, the image guided stuff. So here's what came about. When the CMS and the RUC committee know that they've been looking at the overvalued codes for quite some time. And what they've noticed is that there are a lot of these drainage fluid collection codes through a closed system, in other words the skin percutaneous, that are being done under image guidance. And in fact, it's being done almost 95% of the time. And so, they had decided quite some time ago to take a look at these. And this is the year they've decided to do something about it. So what they've done is they've taken almost all of the drainage codes percutaneous types and added image guidance to the code so that you can no longer report these separately. What that means is that these codes were also revalued so they now include an ultrasound components or guidance components.


So the first one that they changed was 10030, this is image-guided fluid collection drainage by catheter, soft tissue, percutaneous. This is one where the patient on the skin or just under the skin level have some sort of an abscess or hematoma, seroma, lymphocele or cyst. And you can report this not just for the skin but for these kinds of hematomas that are just within the encasement of the abdominal wall. You're not actually opening the patient up to do an exploration of the abdominal cavity but there's something under the skin right into the wall of the abdomen. And those things are being drained via a catheter. And so, that's what this code would be used for.


You don’t report ultrasound guidance separately. But if you have more than one collection that had to be trained and you used a separate catheter to do it, so not when you're putting in the catheter and then moving it around the area to drain different pockets but when you actually stick in separate drains, you could report each one separately.

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