What You Must Know About Revised Consult Guidelines
Published on Thu Jan 26, 2006
Remember: 1 consult per inpatient stay is the limit CPT 2007 has added instructional text to help you decide when you should report a consultation service, and now makes clear that you should not claim a consult if the surgeon assumes responsibility for management of even a portion of the patient's condition(s). Inpatient Language Changes, Rules Don-t You-ll find a new definition for inpatient consult codes 99251-99255, but the changes only serve to clarify already standing guidelines.
The new descriptors for 99251-99255 eliminate the word -initial- and now specify simply, -Inpatient consultation for a new or established patient --
-When CPT deleted the follow-up inpatient codes (99261-99263) for 2006, the need to identify 99251-99255 as -initial- became redundant,- says Suzan Hvizdash, CPC, CPC-EMS, CPC-EDS, physician educator for the University of Pittsburgh and American Academy of Professional Coders National Advisory Board member. -Deleting -initial- from the code descriptor seems like a bit of housekeeping.
-The descriptor change doesn't alter the way in which you-ll apply these codes,- Hvizdash says. -You may report 99251-99255 for the surgeon's first visit with the patient per inpatient stay, as long as the service meets all the requirements of a consult. You should report all follow-up facility visits during the same inpatient stay using subsequent care codes.-
CPT 2007 has also added text preceding the inpatient consult codes that explicitly reinforces this advice: -Only one consultation should be report 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.
Example: The managing physician requests that your surgeon provide a consultation for a hospital inpatient complaining of rectal bleeding (569.3, Hemorrhage of rectum and anus). The surgeon documents the request, examines the patient and shares his findings with the managing physician.
In this case, you should report an inpatient consult (for example, 99254) and any diagnostic tests the surgeon provides (for example, 45330, Sigmoidoscopy, flexible; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]).
Don't forget: You must append modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) to the consult code in this case because the surgeon provided a same-day procedure.
The next day, the managing physician once again asks the surgeon to examine the patient because of new symptoms. Again, the surgeon documents the managing physician's request, examines the patient and shares his findings with the requesting physician.
For the follow-up visit, claim subsequent hospital care (for instance, 99232, Subsequent hospital care, per day, for the evaluation and management of a patient ...). Although this visit may look like a consult, you must report subsequent care.
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