Podiatry Coding & Billing Alert

Question: The podiatrist recently consulted on a new Medicare patient. Medicare no longer accepts the consult codes. What code should I report?

North Dakota Subscriber

Answer: With the no-pay policy on office consultation codes (99241-99245, Office consultation for a new or established patient ...) and inpatient consultation codes (99251-99255, Inpatient consultation for a new or established patient ...), CMS is poised to allow specialists to bill initial hospital care for their first visit with an inpatient. It helps to stop thinking of these hospital care codes as admit codes.

How it works: If your podiatrist performs a consultation in the hospital, you should use an initial hospital code (99221-99223) or subsequent hospital visit code (99231-99233), according to Medicare's new consultation guidelines for 2010.

In the past, only the admitting physician reported initial hospital care codes (99221-99223, Initial hospital care ...), and specialists who saw the patient subsequently and separately often billed inpatient consultation codes.

Key: More than one physician can now use an initial hospital care code for the same patient. If two physicians from different specialties are both consulting on a patient, both physicians will use the initial hospital care code.

Catch: Each physician will be able to bill from the 99221-99223 code range only once, after which he or she will report subsequent hospital care codes (99231-99233, Subsequent hospital care, per day, for the evaluation and management of a patient ...) for follow up hospital visits.