Hospital E/M Coding Focus for Cardiology

Here’s How to Ensure You’re Applying the Proper Hospital Procedure Code and Modifier

When you find yourself assigning a code for care your cardiologist provides in the hospital, don't limit yourself to the lowest levels of hospital inpatient codes and subsequent visits. Otherwise, you may raise a payer's red flag and mark your cardiology practice for a future audit.

For instance, physicians generally report 99231 (Subsequent hospital care, per day, for the evaluation and management of a patient) more often than any other subsequent hospital care code, according to CMS data. This means either most subsequent hospital visits are low-level services or doctors routinely under code for inpatient care. As long as your documentation warrants it, you should feel free to report higher-level subsequent hospital care.

Because carriers usually bundle hospital care into postsurgical visits, many cardiologists aren't familiar with the documentation guidelines associated with hospital care for nonsurgical situations, such as myocardial infarction (MI) or congestive heart failure (CHF). So for the subsequent visit scenario, if you pick up the patient's care after another physician - such as a general surgeon - admits the patient to the hospital, you should report from the 99231-99233 code range.

That’s why you need to figure out the elements necessary for reporting each level of hospital inpatient codes, hospital subsequent visits, as well as observation care. You should also investigate when you should apply modifiers. Expert presenter, Terry Fletcher, CPC, CCC, CEMC, CMC, CMSCS, CCS-P, CCS, will unlock the key to hospital coding, including the two midnight rule as it applies to cardiology as well as CMS alerts about H&Ps in the hospital setting.

You’ll walk away with resources illuminating Medicare rules, example documentation, and HPI tips. Plus, you’ll learn how to untangle shared visit scenarios.

This session will help you:

• Determine the criteria you need to meet in order to report critical care
• Find out what you can count as documentation when it comes to verbal versus written orders
• Audit flags: Highlight what Medicare is auditing
• Underline 2014 TCM services transitioning from hospital to office
• Uncover what to do with discharges (inpatient and outpatient) relating to cardiology

Who should attend?: Coders, Billers, Administrators, Physicians, clinicians

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