Do You Report Follow-Up Consults Instead of Subsequent Hospital Care? The OIG Is Watching

Coding can change after the initial consultation
If your endocrinologist reports a string of follow-up inpatient consultation codes (99261-99263) after he performs an initial inpatient consult, you might be sending a red flag to auditors. If your consulting physician sees an inpatient more than twice, chances are good that he has assumed responsibility for a portion of the patient's care and should be reporting subsequent hospital care codes (99231-99233) instead.
Unless you read the chart, you really can't determine whether the physician is managing the patient's care or remaining in a consultative role, says Curtis J. Udell, CPAR, CPC, CMPA, senior advisor at Health Care Advisors Inc. in Annandale, Va. Check out these scenarios to see if you're coding follow-up consults and subsequent hospital care correctly:

Scenario 1: Your physician visits an inpatient to render a requested consultation on the patient's diabetic neuropathy (250.6x). She completes the consultation, necessary reports and treatment that day. She then returns the following day to check the patient's progress and make additional changes to the plan of care.
Code subsequent hospital care: The endocrinologist's second visit indicates that she now manages the patient's neuropathy care, Udell says. You should therefore select the appropriate subsequent hospital care code to report the second visit.
Scenario 2: Your physician visits a patient with thyroid cancer (193) to render a requested consultation. He orders some tests and returns the next day to read the results and complete the consultation. "This typically happens if the consult was initiated late in the day," Udell says.
Code a follow-up consultation: You should report a follow-up inpatient consultation code for the physician's service on the second day. However, if the physician continues to check on the patient and manage care after that, you would most likely start billing subsequent hospital care codes, Udell says.

- Published on 2004-06-21