Gastroenterology Coding Alert

Question: Our gastroenterologists recently began performing consultations with nursing home patients. I am unclear on which CPT code to use.

Michigan Subscriber

Answer: In coding nursing home consultations, you need to be sure to correctly match the appropriate CPT code with the place-of-service indicator for Medicare. Initial inpatient consult codes 99251-99255 "are used to report physician consultations provided to hospital inpatients, residents of nursing facilities, or patients in a partial hospital setting," according to CPT. These codes are appropriate with a place-of-service indicator 32, which denotes an inpatient facility (specifically a nursing facility). Similarly, you would report any follow-up consultations with the same patient using follow-up inpatient consultation codes 99261-99263.

Some coders mistakenly use nursing facility services codes 99301-99316 for nursing home consultations. These codes are appropriate only when the physician provides ongoing care and the requirements of a consult (request, reason and response) have not been met. Note that the request for a consultation can come from any healthcare worker, including a nurse practitioner or social worker, and does not have to come directly from a physician.