Medicare Compliance & Reimbursement - 2014 Issue 6
Coding for Inpatient Visits: The Payer Will Guide Your Code Choice For Inpatients Seen After Admission
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Article Overview
This article covers inpatient evaluation and management coding for patients seen after admission, with emphasis on how payer policy affects code selection and documentation expectations. It is written for coders who handle hospital-based E/M services and need to understand the general distinctions among consultation, initial hospital care, and subsequent hospital care reporting. The discussion also addresses common documentation considerations, the role of medical necessity, and how billing practices may differ from emergency department E/M services.
Why This Topic Matters
Correctly identifying the applicable inpatient E/M service can affect compliance, claim accuracy, and reimbursement. The topic is especially relevant when payer policy and CPT guidance do not align in the same way across consultation and hospital care reporting.
Article Sections
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Consultation, Initial Hospital Care or Subsequent Hospital Care? Check the Payer Policy First
Introduces the setting in which an admitted patient is seen after admission and explains why payer policy is central to choosing the applicable inpatient E/M category. Also discusses the general comparison between consultation and hospital care reporting.
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Only Two Out Of Three E/M Components Are Required For Subsequent Care Codes
Reviews the general framework for subsequent hospital care reporting and contrasts it with the component requirements used for other E/M services. Includes a broad discussion of documentation patterns and service-level selection.
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Use H & P Documentation to Unlock Subsequent Care Claims
Focuses on how interval history and related documentation support subsequent care claims and help establish medical necessity. Discusses the role of the history and physical narrative in determining the level of service.
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MDM Will Often be the Deciding Factor for Subsequent Care Code Choice
Summarizes how medical decision-making and overall patient status influence selection within the subsequent hospital care category. Provides general guidance on factors that may affect the reported service level.
What You Will Learn
- How inpatient E/M reporting differs from emergency department E/M reporting
- How payer policy can affect the choice between consultation and hospital care categories
- What documentation themes support subsequent hospital care reporting
- How medical necessity and medical decision-making relate to service-level selection
- Which general patient-status patterns are associated with different levels of subsequent hospital care
Who Should Read This
- Medical coders
- Billing professionals
- Hospital coding staff
- Emergency department coding teams
- Revenue cycle professionals
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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