Gastroenterology Coding Alert

Question: I was recently called into the hospital to take over the care of a patient when her previous doctor had to leave town unexpectedly. I began my care three days into her eight-day hospital stay. How should I code for my first inpatient visit with her?


Illinois Subscriber
Answer: CPT states that admitting physicians should use the initial hospital care codes -to report the first hospital inpatient encounter with the patient.- For initial inpatient encounters by physicians other than the admitting physician, you should use initial inpatient consultation codes (99251-99255) or subsequent hospital care codes (99231-99233), as appropriate.

In your case, you seem to have accepted the transfer of the patient's care in advance, and therefore you were not performing a consultation. You would use one of the subsequent hospital care codes, which represent both new and established patients. So, even if you have never met the patient before, you would still bill the 99231-99233 series.