Practice Management Alert

AMS wants -second opinion- billed with E/M codes

Get ready to change the way you code inpatient follow-up and confirmatory consults in the new year. Setting will determine your code choice for inpatient follow-ups, and you-ll replace confirmatory consult codes 99271-99275 with an inpatient or outpatient E/M code.
 
Read on for expert advice on how to implement these changes.

Follow-up consult codes gone:

CPT 2006 eliminates the code set 99261-99263 (Follow-up inpatient consultation for an established patient). Instead, billers should choose from a pair of code sets, depending on the location of service, for inpatient consults next year.
 
Starting Jan. 1, select one of these codes for inpatient consults, says Cindy Hughes, CPC, coding and compliance specialist for the American Academy of Family Physicians in Leawood, Kan.:

- If the physician performs the follow-up consultation in a hospital setting, choose a code from the 99231-99233 family (Subsequent hospital care, per day, for the evaluation and management of a patient).

- If the physician performs the follow-up consultation in a nursing facility, choose a code from the 99307-99310 family(Subsequent nursing facility care, per day, for the evaluation and management of a patient), Hughes says.
 
Good news: In 2005, subsequent care paid more than follow-up consults, says Melanie Witt, RN, CPC, MA, a coding expert based in Guadalupita, N.M. Because you-ll code follow-up consults as subsequent care in 2006, you should be paid at the higher subsequent care rate for follow-up services in the new year.

CPT Takes Another Look at -Second Opinion- Coding

Along with 99261-99263, CPT 2006 eliminates confirmatory consult codes 99271-99275 (Confirmatory consultation for a new or established patient), Hughes says. (These codes are also known as -second opinion- codes.) If your physician provides a confirmatory consult in 2006, you should report an inpatient or outpatient E/M code, such as 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a problem-focused history; a problem- focused examination; straightforward medical decision-making) instead of a consultation code.

This coding change could work out in an office's favor if the physician spends more than 50 percent of the encounter time on counseling or coordination of care, Hughes says. Consider this example:

Scenario: On Jan. 2, Patient Smith, an established patient of Dr. Jones-, reports to the office for a second opinion on whether she should have her gallbladder removed as recommended by another physician. (Smith requested the consult herself.)

Dr. Jones greets the patient and notes the beginning time of the face-to-face encounter. He then reviews Patient Smith's present history of illness, review of systems and past family social history, and notes several past emergency visits for right upper quadrant pain and a gallbladder sonogram report indicating chronic cholecystitis. 
 
After providing a problem-focused exam, Dr. Jones talks to the patient about her medical history, current symptoms, and concerns about the proposed surgery. Dr. Jones advises Patient Smith to follow up with the surgeon's office regarding arrangements for her surgery. At the conclusion of the visit, Dr. Jones documents the end time of the face-to-face encounter.

The total time of the visit was 22 minutes, with 13 minutes spent on counseling. 

Since Dr. Jones spent more than half the encounter time on counseling and coordination of care, you can bill 99213 (... an expanded problem-focused history; an expanded problem-focused examination; medical decision-making of low complexity) for the encounter.