Anesthesia Coding Alert

Question: A transplant surgeon has written an order for our anesthesiologist to see a postoperative inpatient who has complicating factors. The surgeon wants our anesthesiologist, who is on the acute pain management team, to evaluate the patient for pain management requirements and make recommendations. I know that CPT deleted some follow-up inpatient consultation codes (99261-99263, Follow-up inpatient consultation for an established patient ...), but I am not sure which codes I should use to report our provider's visit. Will we be able to get reimbursed for a consultation service?

Pennsylvania Subscriber

Answer: You shouldn't have any problem justifying an inpatient E/M charge. You are correct that the follow-up inpatient consultation codes are no longer valid to report, but you should look at the inpatient consultation code category to report your provider's services.

CPT section guidelines for consultation services indicate the following requirements: a written or verbal request for a consult made by a physician or other appropriate source and documented in the patient's medical record; the consultant's opinion and any services that were ordered or performed must also be documented in the patient's chart and communicated by written report to the requesting physician or other appropriate source.

You have the surgeon's request in writing asking for your anesthesiologist to examine the patient and offer an opinion on his condition and treatment options. You also have the reason for the consult; now your anesthesiologist just needs to document his opinion and findings in the shared inpatient chart to help support a consult code.

How to code it: Look at 99251-99255 (Inpatient consultation for a new or established patient, which requires these 3 key components ...). Then compare your physician's documentation to each of the CPT code key component requirements to help find the correct code.

The notes following each of the consult codes in CPT include an explanation of the corresponding severity of the patient's problem and how long the physician typically spends at the patient bedside and on the patient's hospital floor or unit during that visit level. Generally speaking, here's the breakdown:

• 99251 for visits with the patient or in the patient's unit lasting about 20 minutes

• 99252 for 40 minutes

• 99253 for 55 minutes

• 99254 for 80 minutes

• 99255 for 110 minutes.

Don't forget: Knowing the time your physician spent with the patient is helpful but only provides you with a guide -- not a definitive answer. Time can only be the determining factor for level of service if your anesthesiologist's documentation indicates that more than 50 percent of the total time was spent in counseling and/or coordination of patient care.