Connie, the manager of a case management department, was responsible for the patient discharge transportation budget for patients who did not have a ride home from the hospital. Her role covered all medical-surgical units, but not the postacute recovery room (PACU). However, when she received a desperate call from one of the PACU staff nurses, requesting assistance with a patient who did not have a ride home, she agreed to help. Connie viewed her case management department as being service-oriented and inclusive of all patients, even those beyond her assignment.
In recent years, the federal government has been pushing hospitals to help their patients self-manage chronic conditions. If patients and families aren’t able to sufficiently self-manage their conditions within 30 days of discharge, hospitals may incur reimbursement penalties when these patients are readmitted or need to come back to the emergency department, says Karen Zander, RN, MS, CMAC, FAAN,president and CEO of The Center for Case Management, Inc., in Wellesley, Massachusetts.
Whether it is the CPT Manual or Chapter 12 of the Medicare Claims Processing Manual, the definition of a “new patient” is the same for physicians and nonphysician practitioners billing. But that doesn't mean coding and billing for E/M services is clear cut.
