This is probably one of the best explanations from the Happy Hospitalist that I have ever seen relative to coding.  If you are not in the healthcare business and don’t understand what we all talk about as far as being complicated, read this.  He use his great wit and humor to make the point. 

This is just a teaser here, go to the link at the bottom for the whole story, complete with all the graphics you want to lay your eyes on, and gee this is only one code out of many.  You can see the doctor’s cheat card he carries with him too in order to make the appropriate assessment and bill correctly.  No wonder we have clearinghouses to double and triple check these things. BD 

My first coding clinic was the 99231, better known as the wave from the door code as you walk by the room. Next up is the 99232, the mid level hospital follow up code. Where you actually have to at least look at the patient to qualify.

How does the AMA define a 99232?

Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Physicians typically spend 25 minutes at the bedside and on the patient's hospital floor or unit.

25 minutes?  Really.  In my state a 99232 pays $6o.  That works out to $144 an hour if in fact a 99232 really took 25 minutes.  A colonoscopy without specimen collection (45378), pays about $180 if it's done at the hospital,  $330, if it's done at the docs office.  If you do a single biopsy (45380), it pays $220, if done at the hospital, $400 if it's done at the docs office. I'm pretty certain after several thousand of 'em, I could do at least two an hour, maybe three.   This also explains why every colonoscopy has a random biopsy.  You would be throwing away $80 an hour not to do it.  You do the math.  $144 an hour for cognitive care, or $800 an hour or more for screening colonoscopies at the office. 

The Happy Hospitalist: Coding Clinic 99232


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