Tricky Hospitalist Billing Scenarios

There are some common, yet unclear billing scenarios all physicians are due to encounter during their career. Here are some tricky hospitalists billing scenarios we have come across:

Assessment billing codes vs. consult billing codes

If the physician is called upon to see a patient because the most responsible physician (MRP) has stepped out then you should use your assessment billing codes (usually A007A) with the special visit premium. If the physician has a written referral to see a patient then you should use your consult billing codes (usually A005A) with the special visit premium. Any billing codes relating to consults can only be used if the physician has a written referral from another physician; otherwise it is considered an assessment.

Awaiting long term care (ALC) patient status

When a patient’s status is changed to ALC you should not bill for discharge (C124A), you should only bill for discharge if the patient is physically leaving the facility. On the last day the physician sees the patient and changes their status to ALC you should bill for a subsequent visit (C002A). If a patient with status ALC becomes sick and the physician begins to treat them again you should continue to bill for subsequent visit (C002A). When the patient physically leaves the facility to go to a nursing home then you should bill for discharge (C124A).

Multiple weekly visits (past 5 week stay)

If a patient  has been in the hospital for more than 5 weeks you should bill for subsequent visits using C007A (instead of C002A) which can be used to a maximum of 3 times per week. If the patient becomes very ill and the physician needs to see them more than 3 times per week then the physician can; but they will not get paid for more than 3 subsequent visits in a week. However, if the patient becomes ill with something other than what the physician was initially treating them for then you can bill for intercurrent illness (C121A) and there is no maximum limit on that code.

Patient passing

If a patient passes the MRP can bill for discharge (C124A). If a physician has pronounced a patient dead for which he is not the MRP you should bill for pronouncement of death (C777A).  This may include filling out the death certificate and visiting with the patient's family but are not required to bill for pronouncement of death. If another physician pronounced the patient dead and the physician only fills out the death certificate then you bill for certification of death (C771A). You cannot bill C777A or C771A with other billing codes.