Cardiology Coding Alert

Question: If I report 99255 more than once for the same patient on different days, Medicare does not pay, stating that this is a "duplicate procedure." Is my carrier processing the claim correctly?

Illinois Subscriber

Answer: The descriptor for 99255 (Initial inpatient consultation for a new or established patient ...) clearly indicates "initial" inpatient consultation. CPT further states, "Only one initial consultation should be reported by a consultant per admission." In other words, Medicare is correct in this case.
 
If your physician sees the same patient several times during a single hospital stay, you may report 99255 only for the first visit, assuming that the service was consultative. You must report any subsequent visits with the same patient during the same hospital stay using one of the available follow-up inpatient consult codes (99261-99263) or subsequent inpatient care codes (99231-99233).
 
Subsequent inpatient care would be the correct service type if the physician took responsibility for managing a portion of the patient's care. You would report follow-up inpatient consultation codes when a subsequent visit is necessary to complete the consultation and when a physician requests a second consultation for the patient during the same hospital stay.
 
But, if your physician provides an initial consult for two different inpatient stays for the same patient (for instance, the patient is admitted on Feb. 1, leaves on Feb. 4 and is readmitted on Feb. 6), you may report another initial inpatient consult for the second admission. In this case, you may have to show a new admission date and explain that the patient was readmitted and that the subsequent service was a "new" inpatient consult rather than a follow-up consult during the same admission.