Question: We use codes 99251-99255 for initial hospital consults. But what should we use for follow-up hospital visits after our ophthalmologist has done the initial consult? I'm just not getting the difference between 99231-99233 and 99261-99263. Any help would be much appreciated. Answer: Depending on the situation, you may report either a follow-up inpatient consultation code (99261-99263, Follow-up inpatient consultation for an established patient ...) or a subsequent hospital care code (99231-99233, Subsequent hospital care, per day, for the evaluation and management of a patient ...). On the other hand, if the ophthalmologist assumes patient care, you should assign 99231-99233. Therefore, if the ophthalmologist initiated treatment at the initial consultation and thereafter participated in the patient's management, you should report a code for subsequent hospital care, not a code for follow-up inpatient consultation. Advice for You Be the Coder and Reader Questions provided by Maggie M. Mac, CMM, CPC, CMSCS, consulting manager for Pershing, Yoakley & Associates, Clearwater, Fla; and Raequell Duran, president of Practice Solutions, Santa Barbara, Calif.
New Mexico Subscriber
Use 99261-99263 when:
1. the attending physician requests a subsequent consultative visit from the ophthalmologist, and
2. the ophthalmologist performs the follow-up visit to complete the initial consultation.
Documentation tip: Unlike an outpatient consultation (99241-99245, Office consultation for a new or established patient ...), codes 99261-99263 do not require that the ophthalmologist send a written report to the attending physician. The attending physician should record the request, review and report in the patient's shared medical chart.