Coding Consult

May 19, 2006

Answers to your questions about...hospital stress tests; after-hours visits; reporting ED codes

Hospital stress tests

Q. A patient presented with chest pain (786.50) and heart palpitations (785.1), and I used the hospital's equipment to perform a cardiac stress test. I supervised the test, interpreted the results, and issued a written report. Should I assign 93015?

After-hours visits

Q. I returned to my office (a non-24-hour facility) at midnight to see a patient with cardiac dysrhythmias. What code should I use to report the service?

A. Use the revised after-hours code 99050 (services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed [e.g., holidays, Saturday or Sunday], in addition to basic service). You'd also code 9921x (office or other outpatient visit for the evaluation and management of an established patient . . .).

CPT 2006 revamped the section that contained after-hours codes, and offices now have a single code instead of the three there had been previously. Before this revision, doctors selected an after-hours code based on time and day. For services provided after posted office hours, you used to use 99050 (services requested after posted office hours . . .). When you provided late-night services, you used 99052 (services requested between 10:00 p.m. and 8:00 a.m. . . .). For services that you performed on a holiday or on a Sunday, you used 99054 (services requested on Sundays and holidays . . .).

Reporting ED codes

Q. The hospital called me to admit a patient and I spent one hour with her in the ED but decided not to admit her. How do I code this encounter?

A. If you took over the patient's care from the ED physician, you can bill the appropriate ED services code (99281-99285) for any treatment you rendered. You need to account for only the services provided, not the ED physician's treatment prior to your arrival at the hospital.

You can't use initial hospital care codes or subsequent hospital care codes because the patient wasn't admitted to the hospital.

But if the ED physician called you to provide a consultation and you didn't take over the patient's care, you should report an outpatient consultation code (99241-99245). You must have proper documentation that supports the consultation claim in the patient's chart.

This information is adapted from material provided by the Coding Institute. For a free sample issue or information on how to subscribe to any of 29 specialty-specific coding newsletters, please contact the Coding Institute, 2272 Airport Road South, Naples, FL 34112; phone 800-508-2582; fax 800-508-2592 or visit http://www.codinginstitute.com.