Gastroenterology Coding Alert

Question: Our gastroenterologists recently began performing consultations with nursing home patients. Which CPT code should I use?

Georgia Subscriber

Answer: When reporting nursing home consultations, be sure to correctly match the appropriate CPT code with the place-of-service indicator for Medicare. 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 subsequent hospital care codes (99231-99233) or subsequent nursing facility codes (99307-99310), depending on the site of service.

Red flag: Some coders mistakenly use nursing facility services codes 99304-99316 for nursing home consultations. These codes are appropriate only when the physician provides ongoing care and he does not meet the requirements of a consult (request, reason, render, report and return). 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.