- A General Surgeon performed an appendectomy (V72657) on a patient on December 01. The patient’s medical condition necessitated daily hospital visits from December 01 to December 20 by the General Surgeon, how should the hospital visits be billed?
The visits should be billed as:
- A General Internal Medicine Specialist was referred for continuing care for a hospitalized patient with a severe diabetic condition; the referring medical practitioner was paid daily care for the same condition. The General Internal Medicine Specialist visited the patient from December 01 to December 10 and billed 10 x fee item 00308 (subsequent hospital visit), how should the hospital visits be paid?
Since daily care was already paid to the referring medical practitioner for the same medical condition, the General Internal Medicine Specialist’s claim would be paid as directive care.
The visits for December 01 to December 10 would be paid as 4 x fee item 00306 (directive care) with explanatory codes KI and GR
KI (Another physician has been paid for daily hospital care.)
GR (Directive care is payable at 2 visits per week.)
Preamble D. 4. 5.
An Obstetrician performed a caesarean section (fee item 04050) on a patient on December 01, the patient developed a wound infection on December 03. The Obstetrician provided care for the hospitalized patient from December 02 to December 10 and billed 9 x fee item 04008 (obstetrics hospital visit), why were the hospital visits refused?
Surgical fees include 14 days post-operative follow-up in hospital, unless otherwise indicated by the specific surgical fee billed, wound infection is considered a routine occurrence post surgery. However, when unusual circumstances require that additional medical services are provided in the 14 days following a surgical procedure, an electronic note record should accompany the claim submission outlining the medical necessity and independent consideration will be given.
Generally, the hospital visits would be refused with explanatory code QE.
QE (Service is within the pre or post-operative period.)
Preamble D. 5. 1.
An Orthopaedic Surgeon performed a hip arthroplasty (fee item 55661) on a patient on December 01, the patient developed osteomyelitis on December 03 which progressed to septicaemia on December 07. The Orthopaedic Surgeon provided daily care until the patient was discharged on December 30, how should the hospital visits be billed?
The visits should be billed as:
FROM December 07 TO December 30...........24 x fee item 51008 (orthopaedic hospital visit), as the medical condition (septicaemia) would warrant additional medical care beyond the normal 14 days post-operative care.
The December 02 to December 06 visits for the medical condition (osteomyelitis) is not billable as this would be considered routine and inclusive in the surgical fee.
Preamble D. 5. 1.
A Cardiologist was referred to a hospitalized patient as the responsible physician in charge of the patient’s care. The patient was hospitalized from January 15 to February 25, how should the hospital visits be billed?
If the patient’s medical condition necessitates daily visits, the billing would be:
FROM January 15 TO January 31..............17 x fee item 33008 (subsequent hospital visit).
A Psychiatrist provided psychotherapy to a hospitalized patient and billed fee items 00650 (psychotherapy-hospital or institution in-patient or home) and 00608 (hospital visit) for the same date. Why was fee item 00608 refused?
Fee item 00650 is considered a visit fee and would usually include a hospital visit unless information is received that the patient’s medical condition necessitates 2 separate visits. The payment of the claim could be expedited by providing the times of each visit in the time field or by providing an electronic note record. Otherwise, the second visit would be refused with explanatory code KA.
FROM December 02 TO December 15..........14 x fee item 71008 (post-operative visit, in-hospital - 1 to14 days post-operatively)
FROM December 16 TO December 20..........05 x fee item 07008 (subsequent hospital visit)
The visit fee for December 01 would be refused with explanatory code QG as it is considered inclusive in the payment for the surgery billed on that day.
QG (Service is included in the composite surgical/procedural fee.)
General Surgery Section Preamble
FROM February 01 TO February 25..........17 x fee item 33008 (subsequent hospital visit).
The formula for long-stay is 2 visits per week (7 days) starting on February 14 unless the medical necessity for the extra visits is provided with the claim submission and independent consideration will be given.
KL (Daily care is payable up to 30 days only unless supported by additional information of the medical necessity.)
Preamble D. 4. 2., D. 4. 4. and D. 4. 5.
KA (There is no indication that two separate visits were made. If two visits were performed, please provide times of each visit.)
Preamble D. 4. 2.
Refer to the Specialist Hospital Visits Information
Refer to the Specialist Hospital Visits Billing Tips