# IP E&M Consultation Qutestion



## swtquiet (Oct 27, 2008)

Hello Everyone,  
My name is Suzana and I work for a Pulmonary group in Connecticut. We have 7 physicians in our group who see inpatients and outpatients. I've been a CPC for about a year now and have a question on IP consultations. 
I have a pulmonary physician #1 who was called in by a hospitalist to perform a consult on a patient for Hypoxemia. My pulmonary physician #1 came in and saw the patient and in conclusion stated in the consult letter “patient should take antibiotics as directed and see me PRN.” 
A week later (during the same admission) a cardiologist called my pulmonary physician #2 and asked for a consultation for respiratory pre-op clearance. 
From my impression during my course to obtain my CPC, I would bill a consult for both physicians, but there seems to be some controversy on the matter. Can someone please help me with this? Thanks in advance. 
Sincerely,


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## Anna Weaver (Oct 27, 2008)

*consultation*



swtquiet said:


> Hello Everyone,
> My name is Suzana and I work for a Pulmonary group in Connecticut. We have 7 physicians in our group who see inpatients and outpatients. I've been a CPC for about a year now and have a question on IP consultations.
> I have a pulmonary physician #1 who was called in by a hospitalist to perform a consult on a patient for Hypoxemia. My pulmonary physician #1 came in and saw the patient and in conclusion stated in the consult letter “patient should take antibiotics as directed and see me PRN.”
> A week later (during the same admission) a cardiologist called my pulmonary physician #2 and asked for a consultation for respiratory pre-op clearance.
> ...




According to CPT 2008 Professional edition guidelines page 16 under inpatient consultations:
"Only one consultation should be reported by a consultant per admission. Subsequent services during the same admission are reported using Subsequent hospital care codes (99231-99233 or subsequent nursing facility care codes (99307-99310), including services to complete the initial consultation, monitor progress, revise recommendations, or address a new problem." 

We recently ran into this same issue with a patient who was in hospital and discharged, readmitted a week later with the same principal diagnosis and the second consultation for pulmonary was denied as in the same hospital stay. Medicare indicates a 60 day span between hospital visits or its counted as the same stay. So, our second consultation (even though it's indicated as necessary and all protocol was followed and was in a separate hospital visit) will not be paid so should be billed as subsequent.


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## swtquiet (Oct 27, 2008)

Anna Weaver said:


> According to CPT 2008 Professional edition guidelines page 16 under inpatient consultations:
> "Only one consultation should be reported by a consultant per admission. Subsequent services during the same admission are reported using Subsequent hospital care codes (99231-99233 or subsequent nursing facility care codes (99307-99310), including services to complete the initial consultation, monitor progress, revise recommendations, or address a new problem."
> 
> We recently ran into this same issue with a patient who was in hospital and discharged, readmitted a week later with the same principal diagnosis and the second consultation for pulmonary was denied as in the same hospital stay. Medicare indicates a 60 day span between hospital visits or its counted as the same stay. So, our second consultation (even though it's indicated as necessary and all protocol was followed and was in a separate hospital visit) will not be paid so should be billed as subsequent.




Yes, but this is not for the same "principal diagnosis". Physician #2 was independently requested by the patients Cardiologist who was going to performing surgery. And this was not a matter of coverage, one physician taking over call for another. Two different requesting physicians, two different consulting physicians, and two different diagnosis. This is a little bit of a different scenario.


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## Anna Weaver (Oct 27, 2008)

swtquiet said:


> Yes, but this is not for the same "principal diagnosis". Physician #2 was independently requested by the patients Cardiologist who was going to performing surgery. And this was not a matter of coverage, one physician taking over call for another. Two different requesting physicians, two different consulting physicians, and two different diagnosis. This is a little bit of a different scenario.



Sorry, I see what your saying now. But I would think no matter what the dx would be if it's the same admission, you wouldn't be able to charge a second consult since they are in the same practice. 

Anyone else?


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## mmunoz21 (Oct 27, 2008)

I would have to agree with Anna.  Yes you had physician B do the pre-op clearance consult, but Physican A and B bill under the same tax ID#, and the guidelines state only "ONE" consult per admission, even for a "NEW PROBLEM".

Just my take on it..

Good Luck


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## FTessaBartels (Oct 28, 2008)

*The Rules Changed*

It USED to be that if you had a new problem you could code out another consultation within the same inpatient stay. Your physicians are probably remembering this and not realizing that the rules changed.

As long as the physicians are in the same practice and the same specialty they are considered the same doctor.  *ONE consultation per inpatient visit; all other visits are coded as subsequent hospital visits*. 

F Tessa Bartels, CPC, CPC-E/M


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## swtquiet (Oct 30, 2008)

FTessaBartels said:


> It USED to be that if you had a new problem you could code out another consultation within the same inpatient stay. Your physicians are probably remembering this and not realizing that the rules changed.
> 
> As long as the physicians are in the same practice and the same specialty they are considered the same doctor.  *ONE consultation per inpatient visit; all other visits are coded as subsequent hospital visits*.
> 
> F Tessa Bartels, CPC, CPC-E/M



Thank you so much.


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