General Surgery Coding Alert

In 2006, you'll assign 99231-99233 for all hospital follow-ups

When reporting inpatient consultations, remember that not all facility settings qualify as "inpatient."

Keep in mind that if the surgeon accepts responsibility for any portion of the patient's care, you should report subsequent hospital care rather than a follow-up inpatient consult. Here are full details on the four most important factors to know when considering inpatient consult codes.
 
1. Place of Service Matters

If you're going to report an inpatient consultation, the patient your surgeon sees must have been admitted as an inpatient. Although this sounds obvious, mistakes occur all the time.

"Not all facility settings qualify as 'inpatient,' " says Marvel J. Hammer RN, CPC, CHCO, president of MJH Consulting in Denver. "You can easily make a mistake by thinking, 'The doctor saw the patient in the hospital, so it must be an inpatient service.' But the ED [emergency department], for instance, is an outpatient setting, and doctors provide consultations in the ED all the time."

Specifically, inpatients include patients admitted to hospitals, partial hospital settings, or nursing homes.

Watch for: You should not use inpatient codes for patients the surgeon consults with in the ED or for observation patients, as well as for residents of domiciliary, rest (boarding) homes, custodial care or other "nonskilled" facilities.

2. Claim One Initial Consult per Admission

If you've determined that the patient qualifies for inpatient status - and the available documentation supports a consultation (see "If You're Billing a Consult, Be Sure to Document These 3 Points" at right) - you should choose an appropriate-level initial inpatient consultation code (99251-99255) for the surgeon's first meeting with the patient.

Remember: "You can report 99251-99255 only once per patient per hospital stay," says Michael A. Ferragamo, MD, FACS, clinical assistant professor at State University of New York, Stony Brook.

Example: The managing physician requests that your surgeon provide a consultation for a hospital inpatient recovering from cranial surgery and complaining of abdominal pain (789.0x). The surgeon meets with the patient and conducts a full history and examination. The surgeon prepares a report of his findings and shares them with the managing (requesting) physician.

In this case, you should report an initial inpatient consult (for instance, 99254, Initial inpatient consultation for a new or established patient ...).

Keep in mind: If the patient is discharged and later readmitted, you may report another initial consult.

Example: The patient in the above example leaves the hospital but is readmitted three days later. The managing physician again requests a consult from your surgeon because the patient's previous condition has worsened. You may again report 99251-99255, as appropriate.

3. Additional Same-Stay Consult = Follow-up

There are two circumstances under which you should assign follow-up inpatient consult codes 99261-99263, Hammer says:
 
1. When the physician sees the patient in the hospital a second time because he was unable to complete his assessment at the first visit, or;

2. When an attending physician initially requests a consult from the specialist for an inpatient, but because of the length of the stay and changes in a patient's medical status, the attending requests a second "follow-up" consult to see if the consulting physician has additional recommendations given the changes in patient status.

Example: Two weeks after the initial consultation but during the same inpatient stay, the managing physician in the above example requests a second consult from the surgeon because the patient has developed new symptoms.

In this case, you should choose a follow-up inpatient consult (99261-99263), as supported by documentation.

Documentation tip: Unlike an outpatient consult (99241-99245), 99261-99263 don't require your surgeon to send a written report to the attending physician. The surgeon can record the request, review and report in the patient's shared medical chart.

Get ready for a change: Evidence strongly suggests that CPT will eliminate the follow-up inpatient consult codes (99261-99263) for 2006. If the rumors are true, beginning in January you will report all subsequent hospital care using 99231-99233.

4. Don't Confuse Follow-up With Subsequent Care

If your surgeon assumes responsibility for a portion of the patient's care following an initial inpatient consult, you should report the subsequent hospital care codes (99231-99233, Subsequent hospital care, per day, for the evaluation and management of a patient ...) - rather than the follow-up inpatient consult codes - for the surgeon's follow-up visits with the patient, Ferragamo says.

Example: After the initial inpatient consultation for the patient in the first example above, the surgeon arrives at a diagnosis of cholesterosis (575.6). He reports his findings back to the requesting/managing physician, who asks the surgeon to assume responsibility for that portion of the patient's care. You should report all of the surgeon's subsequent visits with the patient during the same inpatient stay using 99231-99233.