Get To Know What Constitutes an Acceptable Signature

You will soon need to ensure physicians and non-physician practitioners (NPP) sign your paper lab requisitions if you want to get paid; however what does that entail exactly?

CMS provides specific guidance on what constitutes an acceptable 'signature' for documents subject to review for Medicare payment or by an audit contractor. See to it that your documents measure up by complying with one of the following choices:

See to it that it is legible

The simplest signature (but toughest to ensure) is a legible full-name signature or a legible signature using first initial and last name.

Unluckily, you will not find many physicians or NPP who have a legible signature and you certainly won't want to stake your payment on it. That is when you will go to the second option.

Accept printed name with scribble

If you cannot count on ordering physicians and NPP to legibly sign requisitions, you certainly have an alternative. Other personnel such as a circulating nurse can print the full name of the ordering physician/NPP on the requisition. After that the physician/NPP can initial next to or above the full printed name. In this situation, the initials don't have to be legible to count as a legitimate signature.

On the other hand, if you submit a signature log or attestation statement that identifies the signer of an illegible signature, you can meet the signature requirement that way.

Do it: There's no denying that getting referring physicians and NPP to comply with Medicare's just-in policy for acceptable paper requisition signatures will be tough; however, compliance is important if pathologists and laboratories are to continue to be paid for their work.

For more on this, stay tuned to a medical coding guide like Supercoder.com .

Dates and Physician Presence Have a Says In 99221 Use

In a particular situation, a physician treated a patient in the office and then admitted her to the hospital later the same day. Here can we bill for the office visit and the first day of admission, or do we just bill for the hospital stay?

Well, the answer depends on whether the physician sees the patient on the same day in the hospital.

First scenario: If the physician sees the patient in the hospital on the same day in the office, you are looking at two face-to-face visits on the same date. Only report the proper initial hospital care code (99221-99223, Initial hospital care, per day, for the E&M of a patient …). As per CPT coding guidelines, all initial hospital care services that start in another place of location (such as the physician's office) should be combined and coded using the proper level of initial hospital care. As the 99221-99223 code will include the evaluation & management provided in the office, you will report an initial hospital care code that includes the work done in both sites of service; this may lead to coding a higher level of initial hospital care than if you were thinking about the hospital services alone.

Second scenario: However, if the physician doesn't see the patient in the hospital until the next day, bill each encounter separately. Select the proper office visit code (99201-99205, Office or other outpatient visit for the E&M guidelines of a new patient …) or 99212-99215(Office or other outpatient visit for the evaluation and management of an established patient …) for the office visit on the first day. After this, add an initial hospital care code from 99221-99223 for day two, when the physician tends to the patient in the hospital for the first time. Note that CPT uses initial hospital care codes to report the first hospital inpatient encounter by the admitting physician. After that, you will report subsequent hospital care codes 99231-99233 (Subsequent hospital care, per day, for the E/M of a patient . . .), until the time of discharge (date of discharge). When the physician discharges the patient, you will submit the proper hospital discharge day code, 99238 or 99239.