Billing for Medical Daycare

Question: How should we bill medical daycare (MDC) for nursing home orders given over the phone? The doctor will not be visiting the facility.

Answer: Sheri Bernard of the American Academy of Professional Coders supplied the following response:

MDC programs provide daycare for persons with disabilities associated with activities of daily living. Plans of care are developed by the care center in conjunction with the patient’s physician. According to the Medicare Benefit Policy Manual, Chapter 15 (§270, for coverage of telehealth services), “The physician work resulting from telephone calls is considered to be an integral part of the pre-work and post-work of other physician services, and the fee schedule amount for the latter services already includes payment for the telephone calls.”

Medicare considers all work on telephone calls to be bundled into the previous or the next E&M service, so document the telephone calls thoroughly and consider them when selecting the level of history or medical decision making that drives the level of code. Although physicians may select E&M codes based on time when half of their time is spent counseling or coordinating care, that time must be face-to-face with the patient, so the amount of time spent on the phone is not as important as the clinical documentation.