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Gastroenterology Coding Alert

READER QUESTIONS:

If Your Gastroenterologist Assumes Care, Code Follow-Up Visit

Published on Sun Jun 12, 2005

Question: Our gastroenterologist performed a level-two inpatient consultation on a patient complaining of sharp stomach pains, and then saw the same patient a week later for a level-one follow-up visit. What code(s) should I report for these encounters?


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Answer: There are two possible coding choices in this situation. Which one you use will depend on whether your gastroenterologist assumed care of the patient after the consult.
 
Scenario 1: If the attending physician requests a subsequent consultative visit from your gastroenterologist, and your gastroenterologist performs the follow-up visit to complete the initial consultation, you should:
 

  •  report 99252 (Initial inpatient consultation for a new or established patient, which requires these three key components: an expanded problem-focused history; an expanded problem-focused examination; and straightforward medical decision- 
    making) for the initial inpatient consultation.
     
  •  attach ICD-9 code 536.8 (Dyspepsia and other specified disorders of function of stomach) to 99252 to prove medical necessity for the consult.
     
  •  report 99261 (Follow-up inpatient consultation for an established patient, which requires at least two of these three key components: a problem-focused interval history; a problem-focused examination; medical decision-making that is straightforward or of low complexity) for the follow-up visit.

    Scenario 2: If the gastroenterologist began treatment at the initial consultation and thereafter participated in the patient's management, you should:  

  •  report 99252 for the initial consultation.
     
  •  attach ICD-9 code 536.8 to 99252 to prove medical necessity for the initial consultation.
     
  •  report 99231 (Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: a problem-focused interval history; a problem-focused examination; medical decision-making that is straightforward or of low complexity) for the follow-up visit.

    Documentation tip: Unlike an outpatient consultation (99241-99245, Office consultation for a new or established patient ...), 99261-99263 don't require your physician to send a written report to the attending physician. The attending physician should record the request, review and report in the patient's shared medical chart.

    Warning: Codes 99261-99263 will be valid in 2005 but will most likely be discontinued in 2006. Follow-up hospital consultation codes also pay less, level for level (by $10 to $15), than 99231-99233. Therefore, most gastroenterologists will bill subsequent hospital visits when following a patient in the hospital after an initial inpatient consultation.

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