Gastroenterology Coding Alert

Question: One of my doctors provides an initial inpatient consult and then signs off on the patient. Later during the same hospital stay, a different doctor within our group provides another consult for the patient. Is this a follow-up or should I report another initial consult?


Georgia Subscriber

Answer: You may report only one initial inpatient consult (99251-99255) per hospital stay. From a billing standpoint, all physicians of the same specialty in the same group practice are effectively -the same- physician. You cannot get around the initial consult rules simply because two different physicians within the same group practice consulted with the patient.

In this case, you would report an initial inpatient consult for the first consultation.

CPT eliminated the follow-up consult codes 99261-99263 for 2006. Therefore, you should report follow-up visits during the same inpatient stay using either subsequent care codes 99231-99233 (hospital) or 99307-99310 (nursing facility), depending on the site of service.

Another example: Your gastroenterologist receives a request to provide a consultation for a hospital inpatient complaining of rectal bleeding (569.3, Hemorrhage of rectum and anus). The GI physician documents the request, examines the patient and shares his findings with the requesting physician.

You should report an initial inpatient consult code (such as 99254, Initial inpatient consultation for a new or established patient ...) for this visit, as well as any diagnostic tests the gastroenterologist provides (for example, 45330, Sigmoidoscopy, flexible; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]).

Be sure to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the consult code to distinguish the service from the -inherent- E/M component of the same-day sigmoidoscopy.

Two days later, during the same hospital stay, the patient's managing physician once again asks the gastroenterologist to examine the patient because of new symptoms. Once again, the gastroenterologist documents the managing physician's request, examines the patient and shares his findings.

For this same-stay follow-up visit, you should claim subsequent hospital care (for instance, 99232, Subsequent hospital care, per day, for the evaluation and management of a patient ...). Although the visit may look like a consult, you must report subsequent care because the follow-up consult codes (99261-99263) no longer apply.

Clinical and coding expertise for You Be the Coder and Reader Questions provided by Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and a former member of the CPT advisory panel; and Linda Parks, MA, CPC, CMC, CMSCS, an independent coding consultant in Lawrenceville, Ga.