Anesthesia Coding Alert

Confirmatory and follow-up inpatient options are gone

If you find yourself periodically coding for patient consults, don't make the mistake of reporting the standard E/M codes of the past. CPT 2006 drops several commonly used consult codes--and doesn't introduce new codes as replacements.

Confirmatory Consults No Longer Apply

If your pain management specialist gives second opinions regarding a patient's status, you should be familiar with confirmatory consult codes 99271-99275 (Confirmatory consultation for a new or established patient ...). Don't look for them now, though, because CPT 2006 deletes this group of codes.

In the past: Under the old guidelines, a patient might have requested a confirmatory consultation from a pain management physician before a neurologist administered a permanent nerve block. For example, the patient might seek a second opinion if the neurologist recommended a neurolytic block of the trigeminal ganglion to treat trigeminal neuralgia (tic douloureux). You would have reported a choice from 99271-99275. 

Today's code: With confirmatory consult codes no longer an option, CPT instructs you to report -the appropriate E/M service code for the setting and type of service (e.g., consultation)- instead.
 
Example: A physician asks your pain management specialist to provide a consult before scheduling a patient's permanent nerve block procedure. If your physician sees the patient in the office, select the appropriate code from 99241-99245 (Office consultation for a new or established patient ...). If he sees the patient in the hospital, choose from 99251-99255 (Initial inpatient consultation for a new or established patient ...).

-We primarily used confirmatory consults when carriers requested a second opinion,- says Barbara Johnson, CPC, MPC, owner of the consulting firm Real Code Inc. in Moreno Valley, Calif. In these cases, Johnson reminds you to append modifier 32 (Mandated services) to the E/M code.

Bid Farewell to Follow-up Inpatient Consults, Too

CPT 2006 also deletes follow-up inpatient consult codes 99261-99263 (Follow-up inpatient consultation for an established patient ...). Now you must select from 99231-99233 (Subsequent hospital care, per day, for the evaluation and management of a patient ...).

Some coders believe practitioners often misunderstood and abused the old follow-up inpatient consult codes. CPT meant for you to use the follow-up consult codes if your physician performed a consult and was asked to perform a second consult on the same patient within a few weeks,  Johnson says. Instead of relying on the codes for these situations, Johnson says some groups reported the codes for daily visits following an initial consult.

But now follow-up consultations are the same as subsequent care, says anesthesiologist Scott Groudine, MD, of Albany, N.Y.

An anesthesiologist or pain management specialist could use the subsequent care codes when he visits a patient he has already had contact with.

Example: Many patients--but not all--have epidurals or PCA (patient-controlled analgesia) following surgery. You can report a subsequent care code if the anesthesiologist visits a patient to monitor her pain when she isn't using medication.

Bonus use: Carriers do not usually pay for PCA follow-up. If the physician documents an exam and decision-making when he checks on a PCA patient, Johnson says, you can bill 99231-99233 for the visit.