Practice Management Alert

Question: Our anesthesiologist was consulted for a possible emergency intubation. When he arrived and completed his evaluation, the tube wasn’t necessary. He wants to bill a consult for the service (the total time was 30 minutes). The anesthesiologist has always billed 99231 for this type of situation in the past, but I think it should be 99221. Which is correct?

Arkansas Subscriber

Answer: The answer can be payer specific -- and also will depend on the level of history, physical exam, and medical decision making.

Medicare resources indicate that the initial evaluation by an inpatient physician can be billed using the initial code 99221 (Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components: A detailed or comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward or of low complexity …). Note that a patient might have multiple initial evaluations in a single day, if multiple physicians from different specialties see her.

Option: Because some evaluations may not meet the requirements for 99221, payers shouldn’t find fault with those who use a "subsequent" code even if it’s the initial service (assuming the subsequent code better describes the level of service). In that case, you might be better served by reporting 99231 (Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; Medical decision making that is straightforward or of low complexity …).