Coding and Billing Pearls
Attending Preferences
Dr. McCluskey: Check cosign box for all notes, he will attest to working with you but won't officially take over your note and cosign them. Bill either E&M services or critical care depending on level of care provided
Dr. Hou, Dr. Pasca and Dr. Dorotta: Bill either E&M services or critical care depending on level of care provided
Dr. Cheek: Check cosign box for all notes, he will take over note after rounds and will sign them as his own. He works for a different department so we cannot share billing. Do not bill for any daily care only for procedures provided UNLESS you speak with him first (for instance, sometimes he will let you see and bill for a Stringer patient and he won't see them, but this is very, very rare).
Billing Criteria for Critical Care Services
Split-Shared E&M Billing
Billing Criteria for Standard Inpatient Services
The only exclusion to the above billing patterns occurs if you decide to discharge someone out of LLUMC (to a SNF, home, Kindred etc.) and you are going to do it in the AM and not round on them or make a plan for them for the day. This rarely happens, but if it does.... you don't have to write a progress note. You can write a d/c summary. Include a physical exam upon discharge in it and explain how much time you spent (< or > 30 min) getting them out the door. Also be sure to include what return precautions you sent the patient with. You can google "return precautions for xyz" if you aren't sure what they might include, but they are usually in the pre-populated patient handouts/information if you pick the right one. Otherwise, write them in the "patient instructions" box.
Other Notes
For now, NPs should defer care of straight Medi-Cal patients to the resident or fellow. NPs can bill level I or II E&M for these patients, but level III E&M or critical care billing require a separate note by the Attending and they are to bill for those patients.
CMS requires a physician write the order for Home Health services, please have your attending complete this order.
Billing Support
You can also always contact our biller, Nancy Hernandez (I think she works from home but she is very quick to respond): her cell is 310-749-4701 and her email is nahernandez@llu.edu