You Might Use 'Subsequent' Care -- Even When it's Not

Why This Topic Matters

The guidance affects how hospitals and physicians code inpatient E/M services under Medicare, especially when documentation and code descriptors do not line up exactly. It is relevant to avoiding claim denials, inconsistent contractor responses, and confusion during the transition away from consultation billing.

Article Sections

1. CMS guidance after consult code elimination

   Introduces the Medicare policy issue created by the discontinuation of consultation billing and frames the question of how to report low-level inpatient care when documentation does not match the most obvious code choice.

2. Payers should overlook initial/subsequent mismatch

   Summarizes CMS commentary on how contractors should treat documentation that supports a different hospital E/M category than the visit type originally documented. It also references the related MLN Matters clarification and Open Door Forum discussion.

3. Save unlisted code for lowest level

   Describes CMS advice about reserving the unlisted evaluation and management code for situations that do not fit the lowest level of subsequent hospital care. The section also notes that contractor guidance had previously varied.

4. Example and coding discussion

   Presents a hospital-surgeon scenario used to illustrate the broader CMS guidance and includes commentary from coding professionals about hospital E/M reporting considerations.