CPT Update in Brief:
Now's the Time to Update Your Consult Coding
Published on Sat Nov 19, 2005
Access modifier 32 for mandated services
The deletion of follow-up inpatient (99261-99263) and confirmatory (99271-99275) consultations in CPT 2006 means that you must claim all same-stay inpatient follow-ups using subsequent care codes 99231-99233 (hospital) or 99307-99310 (nursing facility)--depending on the site of service--according to new-for-2006 CPT guidelines, says Suzan Hvizdash, BSJ, CPC, physician education specialist for the department of surgery at UPMC Presbyterian-Shadyside in Pittsburgh.
You may, however, still claim initial inpatient consults (99251-99255) for the first consult your gastroenterologist provides per inpatient stay, Hvizdash says.
Likewise, CPT 2006 has deleted 99271-99275. For so-called -second (or third) opinions,- you should access -the appropriate E/M service code for the setting and type of service,- such as an office visit (99201-99215) or consult (99241-99255), CPT states.
Patients can't request a consult: Be aware that a consult must come from -an appropriate source,- which does not include the patient or patient's family. An E/M service requested by the patient or the patient's family -and not requested by a physician, is not reported using the consultation codes but may be reported using the office visit codes, as appropriate,- as outlined by CPT 2006.
As in previous years, however, if a payer mandates the E/M service for a second or third opinion, you should append modifier 32 (Mandated services) to the appropriate E/M service code.
Get the whole story: For complete information on changes to consult coding in CPT 2006, see -Expect a New Year Makeover for Consult Coding- on page 75 and -Easy Inpatient Consult Coding in Just 3 Steps- on page 77 of the October 2005 Gastroenterology Coding Alert.
