Inpatient Facility Coding & Compliance Alert

Question: The cardiologist on call in the hospital was called in for a cardiology consult on a patient. He had never seen the patient before, and probably will never see her again. Which codes should we report?

New Jersey Subscriber

Answer: The following assumes you are not reporting consult codes, since Medicare no longer accepts the codes for those services.

In the inpatient setting, report the consultations with the appropriate hospital care code (99221-99223, Initial hospital care, per day, for the evaluation and management of a patient …). The admitting physician should submit modifier AI (Principal physician of record) to indicate he is the physician of record. The different specialties and modifier AI should prevent any denials for duplicate hospital E/M codes on the same day for the same patient.

Bonus tip: If you were coding this situation in an outpatient setting, you would use office visit codes 99201-99205 (Office or other outpatient visit for the evaluation and management of a new patient …).