Daily Care Conundrums

Code These Cases

Case 1: A 65-year-old patient is admitted for chest pain and to rule out myocardial infarction. The patient also has chronic obstructive pulmonary disease (COPD) and type 2 diabetes. The cardiologist manages the patient’s cardiovascular compromise, while the hospitalist provides daily care for COPD and diabetes. What service(s) can the hospitalist report?

The Solution

The medical necessity of each service and the expertise of each hospitalist is evident. The hospitalist reports appropriate subsequent hospital care code 9923x with 250.00 (diabetes mellitus without mention of complication, type 2 or unspecified type, not stated as uncontrolled and 496 COPD, not otherwise specified). Modifier 25 may be required by some payers when the hospitalist and the cardiologist submit a subsequent hospital care claim on the same day, and payment is never guaranteed. If denied, appeal with both sets of documentation.

Case 2: A hospitalist admits an uncontrolled diabetic patient after midnight. Later that day, the patient’s internist assumes care of the patient. If the hospitalist provides night coverage for the internist on the second day and each hospitalist saw the patient on the second day and addressed the diabetic condition, what should each hospitalist report on Day 2?

The Solution

The internist who assumed complete care of the patient can report appropriate subsequent hospital care code 9923x associated with 250.02 (diabetes mellitus without mention of complication, type 2 or unspecified type, uncontrolled). The hospitalist’s service may be difficult to justify for additional payment because he provided coverage for the internist, they are physicians of the same specialty, and each treated the same condition. If the hospitalist reports his service and the payer receives this claim before the internist’s, the hospitalist may be paid and internist denied. To recover costs and avoid internal conflict, some hospitalist groups contract with the hospital and receive a stipend for night coverage. It is best to seek legal advice before pursuing this option to prevent inappropriate arrangements.