Pediatric Coding Alert

Question: Can I bill for a consultation if the physician is comanaging care of a patient?

South Carolina Subscriber

Answer: Yes, this is possible. Consider a situation in which a specialist gets involved initially during a consult and then shares an ongoing co-management role in the treatment of the patient.
 
For instance, a pediatrician asks for a consultation from an infectious-disease specialist for the treatment of a child who has been hospitalized with pneumonia (487.0). The child also has severe dehydration (276.5) due to vomiting. The infectious-disease specialist performs the consultation, initiates care, and then continues to participate in the patient's management for the pneumonia. The patient is comanaged by the pediatrician, who continues to treat the child for the dehydration. It is optimal for each physician to link his services to a different ICD-9 diagnosis whenever possible.
 
The infectious-disease specialist can code the initial visit as a consult - if the service meets all of the requirements - using a code from the initial inpatient consultation series (99251-99255), depending on the key components. To code the ongoing patient management services delivered in the hospital, she would use the subsequent hospital care codes, 99231-99233, according to CPT.

 - You Be the Expert was reviewed by Richard Tuck, MD, FAAP, practicing pediatrician with Primecare Pediatrics of Zanesville, Ohio.