Primary Care Coding Alert

Subsequent care is right-and in 2006 only-choice for inpatient follow-up

CPT 2006's elimination of follow-up inpatient consultations will ease your consult coding choices and should boost your bottom line--here's how.

Next year, you-ll have only one type of inpatient consultation code. CPT 2006 will delete follow-up inpatient consultations (99261-99263, Follow-up inpatient consultation for an established patient -) and confirmatory consultation codes (99271-99275, Confirmatory consultation for a new or established patient -). CPT Eliminates Consult, Co-Management Confusion When the new codes take effect, you won't have to question whether an inpatient consultation is an initial or follow-up consult--a distinction that practitioners have long struggled to comprehend. Many physicians incorrectly use the current follow-up consultation codes, says Susan Callaway, CPC, CCS-P, an independent coding auditor and trainer in North Augusta, S.C.

Now, you should report a follow-up inpatient consultation (99261-99263) for visits subsequent to the initial inpatient consult. During these encounters, the family physician returns to review lab work, studies obtained or the patient's changed status and does not co-manage the case. But CPT 2006 will eliminate this consult/co-management gray area by removing this coding option.

New method: When the new codes are confirmed, you will code all inpatient consults with 99251-99255 (Initial inpatient consultation for a new or established patient -). Beginning in January, you will report follow-up inpatient care with subsequent hospital care codes 99231-99233 (Subsequent hospital care, per day, for the evaluation and management of a patient -). Describe Daily Routine Care as 99231-99233 
 
When an FP receives a proper request for a consult in the inpatient setting, you may claim one initial inpatient consult (99251-99255) per hospital admission. These codes won't change for 2006. However, if the FP sees the same patient during the same inpatient stay, you should report subsequent hospital care codes, not follow-up inpatient consult codes (99261-99263, which CPT 2006 will eliminate).

Example: After an FP renders his opinion on an orthopedist patient's diabetes mellitus (250.xx), the FP continues to check on the patient during his hospital stay. Because the FP is managing the patient's subsequent diabetes mellitus care, you should code the subsequent visits with 99231-99233, says P. Lynn Sallings, CPC, compliance officer for Family Medical Center, Area Health Education Center-Northwest in Fayetteville, Ark.

Avoid the temptation to code the above scenario's diabetes mellitus follow-up management as 99261-99263. Even though you should report 99261-99263 when the visit is -to complete an initial consult,- -CPT did not intend these codes for daily management follow-up,- Sallings says. If, after the initial consult, the physician continues to treat the patient, you should use subsequent care codes, she says.

Good news: Consultation coding whizzes should emerge unscathed from the follow-up codes- deletion. -If you are billing typical family medicine initial consult/follow-up care encounters correctly, these changes [...]