Podiatry Coding & Billing Alert

Question: Our podiatrist was called in to evaluate and treat the patient that is in the hospital. Which E/M code/s should do I use to report the encounter?

Montana Subscriber

Answer: You have not clarified whether the physician was called as a consultant or the primary admitting/attending physician. The answer to that question will decide the E/M code to be used. Let’s say that your physician performed the initial consult on a patient in the hospital. Then you should use an initial hospital code from (99221, Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components:…), (99222, Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components:…), or (99223, Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components:…), according to Medicare’s new consultation guidelines. The physician will perform a detailed history, comprehensive exam, and note down the appropriate medical decision making (MDM) at the bedside of the inpatient.

The admitting physician or the “the physician of record” has to use the initial services code with a proposed modifier AL (Physician of record). Only the admitting physician may file a claim for the initial hospital visit. All other same-day submitted claims for initial hospital care codes will presumably be consultants.

If the patient is already an established inpatient, then your podiatrist will qualify as a consultant physician. You should choose an appropriate-level initial inpatient consultation code from 99251-99255 (Initial Inpatient Consultation Services) for his first meeting with the patient. Make sure that the requesting physician fulfills all the conditions that are required to be documented for a visit to be constituted as a consult. Don’t forget to include the relevant consult documentation and also the podiatrist sends his opinion report back to the requesting physician.