Primary Care Coding Alert

Question: When a family physician performs an inpatient consult, I bill 99251-99255. Should I code a follow-up visit with 99261-99263 or 99231-99233?

Illinois Subscriber Answer: You actually have two code choices for a hospital visit following an initial inpatient consultation (99251-99255, Initial inpatient consultation for a new or established patient ...). Depending on the situation, you may report either a follow-up inpatient consultation (99261-99263, Follow-up inpatient consultation for an established patient ...) or subsequent hospital care (99231-99233, Subsequent hospital care, per day, for the evaluation and management of a patient ...).

Use 99261-99263 when:

1. the attending physician requests a subsequent consultative visit from your FP

2. your FP performs the follow-up visit to complete the initial consultation.

On the other hand, when your FP assumes patient care, you should assign 99231-99233. So if the FP initiated treatment at the initial consultation and thereafter participated in the patient's management, you should report a code for subsequent hospital care, not a code for  follow-up inpatient consultation.

Documentation tip: Unlike an outpatient consultation (99241-99245, Office consultation for a new or established patient ...), 99261-99263 don't require your FP to send a written report to the attending physician. The doctors should record the request, review and report in the patient's shared medical chart.