Orthopedic Coding Alert

Question: Is a nursing home an -inpatient- setting? Specifically, should I use the inpatient consult codes (99251-99255) to report consultations for nursing home residents?

Arizona Subscriber

Answer: Yes, a nursing home qualifies as an inpatient setting, and nursing home residents are therefore inpatients. When reporting services for a nursing home inpatient, enter place of service 32 in box 24B of the CMS-1500 claim form.

And, yes, you should choose the appropriate code from the 99251-99255 range (Inpatient consultation for a new or established patient ...), depending on the service level supported by the physician's documentation. CPT guidelines specifically note that inpatient consultations are appropriate -to report physician consultation provided to hospital inpatients, residents of nursing facilities, or patients in a partial hospital setting- [emphasis added].