# Consults again



## cpccoder2008 (Mar 31, 2010)

Ok here is the senario a medicare patient comes in with a fracture to the leg. Dr. A who is surgery admits the patient and uses the AI modifier. Dr. B who is an ortho does an inpatient consult and bills 99223. Several weeks later the patient is admitted to surgery again, different dx, Dr A does another admit with AI modifier and Dr. B is consulted again, different dx, would Dr. B bill this as an initial visit or subsequent since the patient is not new to him but does present with a new problem ?? Thank you


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## mmelcam (Mar 31, 2010)

The initial hospital visit codes are for new and established patients. I would bill the initial hospital visit for Dr. B again because this is his/her initial visit with the patient during this hospital stay.


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## jillmtom (Mar 31, 2010)

Yes, you can bill another intital visit code 99221-99223.


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## cpccoder2008 (Mar 31, 2010)

would anyone have any documentation stating that ?? I have serveral articles but they only state to code the consult as an initial visit, nothing about if they are consulted again on the next admission.


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## LLovett (Apr 1, 2010)

*It is per admit, not per patient*

Each new provider can charge an initial inpatient for every admit (as long as they meet the requirements of the code).

There is no limit, as long as it is a separate admit and someone else in your group/specialty has not already seen them in this admit, you charge the initial if your documentation supports it. If not, you charge a subsequent. 

The SE1010 MLN supports using the subsequent when documentation is not supportive of an initial. I don't have any links handy but I'm pretty sure everything is referred to as a per admit basis, it always was in the past. With consults you were only allowed one consult per admit even if you were called back for a different issue.

Laura, CPC, CPMA, CEMC


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