General Surgery Coding Alert

Question: My surgeon consulted with a patient for abdominal pain, and he diagnosed cholecystitis. The primary-care physician (PCP) discharged the patient with instructions to see our surgeon for scheduling outpatient surgery. The next week, the patient went back to the emergency department, and the PCP readmitted him and again requested that our surgeon provide a consultation for the same reason.

May we report an inpatient consultation (99251-99255) again, or should we report subsequent care (99231-99233) because we have seen the patient previously for the same diagnosis?

Kentucky Subscriber

Answer: As long as the patient has been admitted for a new inpatient stay, and the service your surgeon provides meets all the requirements of a consultation (and these requirements are documented in the medical record), you may report another initial inpatient consultation, even if the consultation is for the same diagnosis as that used to justify the previous consultation.

Basically, the rule states that you-re allowed one inpatient consult (99251-99255) per hospital stay, regardless of the diagnosis.

Any additional visits your surgeon provides for the patient during the same inpatient stay, however, require you to report as subsequent care (99231-99233) -- you may not report any follow-up visits during the same inpatient stay as a consultation. CPT includes specific instructions stating, "Only one consultation should be reported by a consultant per admission. Subsequent services during the same admission are reported using Subsequent Hospital Care codes 99231-99233 or Subsequent Nursing Facility Care codes 99307-99310," depending on the setting.