Coding Corner, a new section that will appear periodically in The Hospitalist, features common coding and/or billing issues hospitalists regularly face. If you have suggestions for upcoming coding issues you’d like addressed, email us at [email protected].
A 64-year-old woman with a history of heart failure with reduced ejection fraction was admitted to the hospital with orthopnea and dyspnea on exertion for one week. You admitted her to the hospital for intravenous (IV) diuresis and you see her now on day three of her admission. She is diuresing adequately on IV Lasix 40 mg twice a day, but after examination, you feel like she needs another one to two days of IV diuresis. You order another basic metabolic panel to monitor her serum creatinine. You review her basic metabolic panel from the morning labs, speak to the patient’s daughter, and get some more history about the reason for this exacerbation.
Q: What level of billing does this qualify for?
A: This would qualify for level-3 (99233) billing. She would qualify for severe exacerbation of chronic illness by virtue of her being hospitalized (high level in complexity of problem addressed) and drug therapy needing intensive monitoring of labs for toxicity (high level for risk of complication). Even though the complexity of the data reviewed is moderate, she achieved high-level MDM, or medical decision making, in two out of three elements.
Always look at the medical decision making table when billing. A chronic illness that needs hospital admission for exacerbation is usually looked upon as a severe exacerbation, and IV diuretics are common medications that need intensive monitoring of labs for toxicity.
Dr. Mehta is the medical director and an assistant professor of medicine at the University of Cincinnati Medical Center in Cincinnati, and a member of The Hospitalist’s editorial board.