Oncology & Hematology Coding Alert

Question: Our oncologist performed an inpatient consult for a patient admitted through the ED. He discharged the patient, and five days later another physician admitted the same patient back into the hospital. The second admitting physician also called our oncologist for another consult with this patient. Should we charge for a follow-up consultation for the second visit, or should we charge for another inpatient consult?


Tennessee Subscriber


Answer: You can report an initial inpatient consultation code (99251-99255) once per inpatient admission if your physician meets the consultation criteria, according to CPT. Therefore, your oncologist can bill an initial inpatient consult code during each of the patient's two admissions or an outpatient consult if the physician completes the examination in the ED.

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

For example, if the oncologist performed a consult on day one of the patient's stay, and a second consult (at the attending physician's request) on day six, you would report the first visit using an inpatient consult code, and report the second visit using a follow-up consultation code.

Remember that the oncologist should document the request for his opinion, notes from his review of the patient, and his report back to the requesting physician.

CMS recently issued a "Medlearn Matters" article that advises practices how to properly bill consultations. To read the article, visit the CMS Web site at http://www.cms.hhs.gov/medlearn/matters/mmarticles/2005/SE0515.pdf.