General Surgery Coding Alert

Question: Our surgeon was called for an inpatient consult with an auto vehicle accident patient. The patient was discharged and then admitted again five days later by yet another physician. The second admitting physician also called our surgeon for another consult with this same patient. Should we charge for a follow-up consultation for the second visit or should we charge for another inpatient consult?


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Answer: You should report an inpatient consultation code (99251-99255) if the surgeon provides an initial consultation during a different hospital admission.

In contrast, use a follow-up consultation code (99261-99263) when the surgeon provides an additional consult(s) during the same hospital stay.

For example, in your case, the same patient has been admitted on two different occasions, and on each occasion your surgeon provided a consult. Report an appropriate inpatient consult code for each occasion.

In a second example, the patient is admitted to the hospital for a one-week stay. The surgeon provides a consult on day one of the patient's stay, and a second consult on day six of the patient's stay. In this case, report the first visit using an inpatient consult code, and report the second visit using a follow-up consultation code.