Gastroenterology Coding Alert

Re-admission can mean another -initial- consultation

When reporting inpatient consultations, remember that not all facility settings qualify as -inpatient.-

Here are full details on the three most important factors to keep in mind when you are considering inpatient consult codes.
 
1. Watch Your Place of Service

If you-re going to report an inpatient consultation, the patient your gastroenterologist sees must have been admitted as an inpatient. Although this sounds obvious, mistakes occur all the time.

-Not all facility settings qualify as -inpatient,- - says Marvel J. Hammer RN, CPC, CHCO, president of MJH Consulting in Denver. -You can easily make a mistake by thinking, -The doctor saw the patient in the hospital, so it must be an inpatient service.- But the ED [emergency department], for instance, is an outpatient setting, and doctors provide consultations in the ED all the time.-

Inpatients include patients admitted to hospitals, partial hospital settings or nursing homes.

Watch for: You should not use inpatient codes for patients the gastroenterologist consults with in the ED or for patients admitted to observation status, as well as for residents of domiciliary, rest (boarding) homes, custodial care or other -non-skilled- facilities.

2. One Initial Consult per Admission Is the Limit

If you-ve determined that the patient qualifies for inpatient status--and the available documentation supports a consultation--you should choose an appropriate-level initial inpatient consultation code (99251-99255) for the gastroenterologist's first meeting with the patient.

Learn more: For information on documentation requirements for consults, see -Billing Consults? Here Are the Requirements- in this issue.

Remember: -You can report 99251-99255 only once per patient per hospital stay,- says Michael A. Ferragamo, MD, FACS, clinical assistant professor at State University of New York, Stony Brook.
 
Example: The managing physician requests that your gastroenterologist provide a consultation for a hospital inpatient recovering from cranial surgery and complaining of abdominal pain (789.0x). The gastroenterologist meets with the patient and conducts a full history and examination. The gastroenterologist prepares a report of his findings and shares them with the managing (requesting) physician in the hospital chart.

In this case, you should report the initial inpatient consult (for instance, 99254, Initial inpatient consultation for a new or established patient ...).

Keep in mind: If the patient is discharged and later re-admitted, you may report another inpatient consult.
 
Example: The patient in the above example leaves the hospital only to be re-admitted three days later. The managing physician once again requests a consult from your gastroenterologist because the patient's previous condition has worsened. You may again report 99251-99255, as appropriate.

3. Call on 99231-99233 or 99311-99313 for Follow-up

Changes to CPT for 2006 mean that you-ll no longer report follow-up inpatient consults 99261-99263 under any circumstances. Instead, you should choose either 99231-99233 for hospital inpatients or 99311-99313 for nursing home inpatients for all subsequent care the gastroenterologist provides during the same inpatient stay.

Learn more: See -Expect a New Year Makeover for Consult Coding- included in this issue for all the facts.