Health Information Management

Q&A: Reporting services of hospitalists who provide medical clearance

JustCoding News: Inpatient, April 14, 2010

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QUESTION: We have a question regarding documentation and reimbursement for medical clearance that hospitalists provide for psychiatric admissions. We are a teaching hospital and our physicians admit patients to psychiatric services for drug issues, attempted suicide, etc.

For these admissions, our hospitalist group provides the required medical clearance services. We have the following questions and concerns:

  • In most cases, the patient does not have a chronic medical illness or condition. As a result, the hospitalist has only the psychiatric diagnosis to code. Because the psychiatric attending will code the psychiatric diagnosis, I’m not sure the hospitalist will receive reimbursement for the service if he or she reports this diagnosis as well.
  • If the patient has a chronic illness for which the hospitalist offers medical advice prior to proceeding with the psychiatric care, could we code this as a consult?

My questions revolve around the fact that I cannot pinpoint the actual requirements, whether they’re driven by CMS or the Joint Commission (formerly JCAHO). I am not sure whether we could ever code a consult because there seems to be a requirement for the patient to have a medical clearance to do so. Is it possible for us to code any of the visits with subsequent care codes? Or do our hospitalists just have to absorb these services as a requirement of the admission?

ANSWER: Upon admission, an attending is assigned—probably your medical hospitalist. This physician should report what is relevant to the service he or she provided. Therefore, the medical hospitalist should report the confirmed diagnoses (e.g., chronic illness) related to the medical services he or she provided or ordered. Then, the hospitalist should document psychiatric signs and symptoms to support the referral for the psychiatric consult. The psychiatrist would then determine his or her own psychiatric diagnosis on his or her own claim for services he or she provides.

For example, John is admitted to the hospital with open lacerations on the anterior wrists. Dr. Smith, an internal medicine hospitalist, is his attending physician. Dr. Smith repairs the wounds and orders appropriate medications to prevent infection. While he’s performing the history and physical, John tells Dr. Smith that he is very depressed and cut his own wrists. Based on the patient’s self-reported suicidal thoughts, Dr. Smith requests a consultation from Dr. White, the physician on-call from psychiatric services. Dr. White evaluates John and determines cause for a 72-hour psychiatric hold.

Possible diagnosis codes for these services include:

  • For Dr. Smith’s service: code 881.02 (Open wound, wrist)
  • For Dr. White’s service: code 311 (Depressive disorder, not elsewhere classified), and code 300.9 (Unspecified nonpsychotic mental disorder) for the suicidal risk

If the patient receives absolutely no services from the medical hospitalist other than the referral to the psychiatrist, report code V68.81 (Referral of patient without examination or treatment).

If the medical hospitalist is performing a general physical exam to ensure no physical problems prior to the psychiatric consult, coders might report one of the following V codes:

  • V70.5 (Health examination of defined subpopulation).
  • V72.83 (Pre-procedural general physical examination).
  • V72.85 (Other specified examination). Attach documentation to support this service.

Editor’s note: Shelley C. Safian, MAOM/HSM, CCS-P, CPC-H, CHA, of Safian Communications Services in Orlando, FL, answered this question. She is a senior assistant professor who teaches medical billing and insurance coding at Herzing University Online in Milwaukee, WI. E-mail her at ssafian@embarqmail.com.

This answer was provided based on limited information submitted to JustCoding.com. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.



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