Gastroenterology Coding Alert

 Question: One of our gastroenterologists consulted a patient in the hospital (99251-99255). Seven days later, another gastroenterologist in our practice was called in to consult on the same person for a different diagnosis. The patient was still in the hospital. Because Medicare dictates that I cannot bill two consultations during the same hospital stay, how should I bill the second E/M service?

Illinois Subscriber

 
Answer: Medicare and CPT will allow only one initial inpatient consultation per consultant per hospital admission. In addition, Medicare and most other insurers require that physicians in the same practice who are in the same specialty must bill and be paid as though they were a single physician. So you are correct that after the first consultation your practice cannot report any more gastroenterology consultations for that patients current hospital stay.
 
You can use a follow-up inpatient consultation code (99261-99263) to report the second consultation. A subsequent consultative visit may be requested by the attending physician, according to the Principles of CPT Coding, a publication of the AMA. This may be a request for an opinion and/or advice for evaluation and/or management of a new problem or the same problem.
 
Even though its a follow-up consultation, the traditional criteria for a consultation (the request, the review of patient, and the report to the requesting physician) must still be met. However, only two of the three key components of an E/M service (history, examination and medical decision-making) must be considered when determining the level of consultation. Also, the gastroenterologist only has to take an interval, or limited, patient history.
 
If the first gastroenterologist participated in the subsequent care of the patient, you may bill a subsequent hospital care code (99231-99233) instead of a follow-up consultation code for the second gastroenterologist.