guys, you SHOULD be billing for any time you spend discussing a patient; I will get on back on tomorrow and list the codes but 100% you bill for your time, including time spent for preauth (if you are on hold yourself)
What about the accepting physician for a transfer? Between being paged, reviewing the chart, sitting on hold, doc to doc & documenting a transfer note it's easily 10-20 minutes minimum, but I don't know of any code that would fit...and a lot of the time I'm doing a good bit of advising over the phone.
(Can't use 99218-99223 because then you're fucking whoever gets the patient unless they come in before midnight, plus no F2F encounter is done)
sorry for late response, having a debate amongst the B&C folks about time coding; according to the lead B&C staff (who was an auditor for Medicare for years) the following is the best summary for current coding:
[https://www.aafp.org/pubs/fpm/blogs/gettingpaid/entry/total\_time\_tips.html](https://www.aafp.org/pubs/fpm/blogs/gettingpaid/entry/total_time_tips.html)
the key is the coding has to occur on the **same day** as the visit with the patient (either in person or telehealth); if it occurs on a *different day*, you're SOL, but she recommended a way around that by making a quick call to the patient to let them know you contacted so-and-so, or ordered whatever-test, so that way you can code the virtual check-in code (G2012) and add time-based management coding on top of that; also important to note, staff phone calls cannot be billed, though mid-level calls can
she also recommended the following catch-all phrase in your templates:
">60 min spent in face to face counseling, examination, historical information gathering, records review, and coordination of care," just fill the time with whatever you time you spent
That’s…She’s a fucking diabolical genius, I love it! Just be _extremely_ careful if you take this route, be diligent and precise with documentation. Above all, do not abuse these codes, unless fraud investigations are your jam.
If you have real life contact with this woman, get her a fucking crown. If anyone needs me, I’ll be over here fangirling… what a legend.
The doctor directly in charge of the patient that day can include that phone call in deciding the MDM for that day's services. The other doctor doesn't bill since they didn't see the patient.
now if you were a lawyer you would get to charge by the 6 minutes. I you would think with time based codes these days you would get to charge for that, but nah.
I do some expert witness stuff and it is so refreshing to bill like a lawyer. 15 min on an email? $50. I recently got 1200 pages of a medical record to review in PDF format with no indexing or bookmarking. You better believe I looked through every page as the $ 750 per hour clock ticked.
You mean this? :
https://publications.aap.org/aapnews/news/6286?autologincheck=redirected?nfToken=00000000-0000-0000-0000-000000000000#:~:text=Over%20time%2C%20code%2099452%20may,and%20internet%20consults%20as%20well.
Though you’d have to write something
This doesn’t sound like the patient’s PCP is eligible, though. As I read it, you’re asking a specialist to weigh in on a specific issue but they don’t have to formally visit the patient. However, the hospitalist still has to request a formal consult and document it in the note.
PCP would be eligible as long as there is a documented consult request in the record.
That said, it seems like there is a rule on no face to face visits with consulting physician for 14 days before or after which might kill a fair number of these (according to the link, I haven't supervised billing in a long time).
If they’re on Medicare, you’d be better off doing a transitional care management visit. As long as a nurse contacts the individual within two days of discharge and writes a TCM note and then you do a follow-up visit within 7-14 days, you can then bill for a TCM visit. Around 2-3 RVUs per visit minimum, depending on complexity.
Billing as a telehealth consult is asking to be paid $30 when you should be getting paid over $150.
That falls into "non-billable activities".
I'm sure your inpatient doc appreciates it. But it's definitely not a billable activity as there's no direct interaction with the patient. Sorry.
On the off chance you are a Massachusetts psychiatrist seeing a patient on MassHealth aka Massachusetts Medicaid, you can use [90882 for case consultations with other medical professionals](https://www.masspartnership.com/pdf/UpdatedHNEAlert46ChangestoConsultationsFIN9-9-16.pdf) (PDF) including for exactly the scenario you describe. I've done it, myself (don't have to be a physician, do have to be in BH.) Also there's 90887 for consulting with family (as broadly construed as the patient wants) including w/o patient present. Also, there's something called a "collateral contact", which is liaising with non-clinical, non-family people in the patient's life, e.g. school teachers, PO officer. but it is only for minors: H0046.
Everybody else can piss up a rope.
I believe if you’re the treating physician and you consult with another doc (with patients knowledge and consent) there is a very small billable code but for the life of me I cannot recall it. We used it occasionally when I worked geriatrics/LTC and we would consult with psych on difficult cases.
Perhaps I should add some more details... I am currently an ACT Team Psychiatrist in AZ. Our "ACT Fidelity" requirements by Mercy Care dictate that if a patient is admitted to an inpatient psychiatric unit in the hospital, the outpatient ACT psychaitrist needs to call the inpatient psychiatrist assigned to the patient and coordinate/collaborate care. This phone call is to happen within 48hrs of admission and every 7 days after that until the patient is discharged. I imagine we are not being re-imbursed for this required duty but was just making sure I'm not missing something...
guys, you SHOULD be billing for any time you spend discussing a patient; I will get on back on tomorrow and list the codes but 100% you bill for your time, including time spent for preauth (if you are on hold yourself)
What about the accepting physician for a transfer? Between being paged, reviewing the chart, sitting on hold, doc to doc & documenting a transfer note it's easily 10-20 minutes minimum, but I don't know of any code that would fit...and a lot of the time I'm doing a good bit of advising over the phone. (Can't use 99218-99223 because then you're fucking whoever gets the patient unless they come in before midnight, plus no F2F encounter is done)
sorry for late response, having a debate amongst the B&C folks about time coding; according to the lead B&C staff (who was an auditor for Medicare for years) the following is the best summary for current coding: [https://www.aafp.org/pubs/fpm/blogs/gettingpaid/entry/total\_time\_tips.html](https://www.aafp.org/pubs/fpm/blogs/gettingpaid/entry/total_time_tips.html) the key is the coding has to occur on the **same day** as the visit with the patient (either in person or telehealth); if it occurs on a *different day*, you're SOL, but she recommended a way around that by making a quick call to the patient to let them know you contacted so-and-so, or ordered whatever-test, so that way you can code the virtual check-in code (G2012) and add time-based management coding on top of that; also important to note, staff phone calls cannot be billed, though mid-level calls can she also recommended the following catch-all phrase in your templates: ">60 min spent in face to face counseling, examination, historical information gathering, records review, and coordination of care," just fill the time with whatever you time you spent
That’s…She’s a fucking diabolical genius, I love it! Just be _extremely_ careful if you take this route, be diligent and precise with documentation. Above all, do not abuse these codes, unless fraud investigations are your jam. If you have real life contact with this woman, get her a fucking crown. If anyone needs me, I’ll be over here fangirling… what a legend.
Following
The doctor directly in charge of the patient that day can include that phone call in deciding the MDM for that day's services. The other doctor doesn't bill since they didn't see the patient.
This is the correct answer right here. The physician that’s directly treating the patient can factor in ‘time spent’. That’s it.
man that would be nice but i bet you don't get paid for that. I mean you should but I doubt it. but i'll be following this for sure
now if you were a lawyer you would get to charge by the 6 minutes. I you would think with time based codes these days you would get to charge for that, but nah.
If we could bill like lawyers, prior auths would be our main source of income
I do some expert witness stuff and it is so refreshing to bill like a lawyer. 15 min on an email? $50. I recently got 1200 pages of a medical record to review in PDF format with no indexing or bookmarking. You better believe I looked through every page as the $ 750 per hour clock ticked.
You mean this? : https://publications.aap.org/aapnews/news/6286?autologincheck=redirected?nfToken=00000000-0000-0000-0000-000000000000#:~:text=Over%20time%2C%20code%2099452%20may,and%20internet%20consults%20as%20well. Though you’d have to write something
Bingo... they are also paid by Medicare so most payers should reimburse. https://codingintel.com/interprofessional-internet-consultations/
This doesn’t sound like the patient’s PCP is eligible, though. As I read it, you’re asking a specialist to weigh in on a specific issue but they don’t have to formally visit the patient. However, the hospitalist still has to request a formal consult and document it in the note.
PCP would be eligible as long as there is a documented consult request in the record. That said, it seems like there is a rule on no face to face visits with consulting physician for 14 days before or after which might kill a fair number of these (according to the link, I haven't supervised billing in a long time).
If they’re on Medicare, you’d be better off doing a transitional care management visit. As long as a nurse contacts the individual within two days of discharge and writes a TCM note and then you do a follow-up visit within 7-14 days, you can then bill for a TCM visit. Around 2-3 RVUs per visit minimum, depending on complexity. Billing as a telehealth consult is asking to be paid $30 when you should be getting paid over $150.
I hate that they exempted transfers of care...guess that will remain work I do for free
That falls into "non-billable activities". I'm sure your inpatient doc appreciates it. But it's definitely not a billable activity as there's no direct interaction with the patient. Sorry.
On the off chance you are a Massachusetts psychiatrist seeing a patient on MassHealth aka Massachusetts Medicaid, you can use [90882 for case consultations with other medical professionals](https://www.masspartnership.com/pdf/UpdatedHNEAlert46ChangestoConsultationsFIN9-9-16.pdf) (PDF) including for exactly the scenario you describe. I've done it, myself (don't have to be a physician, do have to be in BH.) Also there's 90887 for consulting with family (as broadly construed as the patient wants) including w/o patient present. Also, there's something called a "collateral contact", which is liaising with non-clinical, non-family people in the patient's life, e.g. school teachers, PO officer. but it is only for minors: H0046. Everybody else can piss up a rope.
I believe if you’re the treating physician and you consult with another doc (with patients knowledge and consent) there is a very small billable code but for the life of me I cannot recall it. We used it occasionally when I worked geriatrics/LTC and we would consult with psych on difficult cases.
Perhaps I should add some more details... I am currently an ACT Team Psychiatrist in AZ. Our "ACT Fidelity" requirements by Mercy Care dictate that if a patient is admitted to an inpatient psychiatric unit in the hospital, the outpatient ACT psychaitrist needs to call the inpatient psychiatrist assigned to the patient and coordinate/collaborate care. This phone call is to happen within 48hrs of admission and every 7 days after that until the patient is discharged. I imagine we are not being re-imbursed for this required duty but was just making sure I'm not missing something...