Otolaryngology Coding Alert

Question: When an otolaryngologist performs an inpatient consult, I bill 9925x. Should I code a follow-up visit with 9926x or 9923x?

Illinois Subscriber

Answer: You actually have two code choices for a hospital visit following an inpatient consultation (99251-99255, Initial inpatient consultation for a new or established patient ...). Depending on the situation, you may report either a follow-up inpatient consultation (99261-99263, Follow-up inpatient consultation for an established patient ...) or inpatient hospital care (99231-99233, Subsequent hospital care, per day, for the evaluation and management of a patient ...).
 
Use 9926x when:
 1. the attending physician requests a subsequent consultative visit from your otolaryngologist
 2. your otolaryngologist performs the follow-up visit to complete the initial consultation.

On the other hand, when your otolaryngologist assumes patient care, you should assign 99231-99233. That means if the physician initiated treatment at the initial consultation and thereafter participated in the patient's management, you should report a subsequent hospital care code, not a follow-up inpatient consultation.
 
Documentation tip: Unlike an outpatient consultation (99241-99245, Office consultation for a new or established patient ...), 9926x doesn't require your otolaryngologist to send a written report to the attending physician. The doctors should record the request, review  and report in the patient's shared medical chart.