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 shouldn't have any impact,- Sallings says.

Replace 99261-99263 With Subsequent Care Code

Specialists will, however, have to revise their follow-up consultation coding. If you still want to nail down follow-up consultation versus subsequent care, take a look at the following example.

Scenario: An FP admits a patient to the hospital for malignant hypertension. During his hospital stay, the patient develops chest pain and the FP requests a cardiologist's opinion. The cardiologist sees the patient and wants to run some tests. The next day, he returns with the test results, discusses his findings with the patient and renders his opinion. You would report the FP's daily E/M services, such as 99221-99223 and 99231-99233.

The cardiologist's coder would now report an initial consultation (99251-99255) and a follow-up inpatient consult (99261-99263). -Because the cardiologist has to return to complete the consult, the second encounter qualifies as a follow-up consult,- Sallings says. Next year, CPT will eliminate this option, so the other coder will have to charge subsequent hospital care (99231-99233).

Use Separate Diagnoses to Combat E/M Rejections

Paying attention to diagnostic coding will help you avoid denials for two same-day E/M services by different specialists (sometimes referred to as -concurrent care-).
In the above subsequent care scenario involving the hypertension/chest pain patient after the initial consult, the FP and cardiologist should both report subsequent hospital care (99231-99233). Therefore, the insurer will receive two subsequent hospital care claims for the same patient on the same date of service.

Key: Each physician must report the condition(s) he cares for to ensure that the dual charge doesn't trigger a denial. -ICD-9 instructs the physician to list all of the diagnoses he addressed during that exam,- Callaway says.

For the hypertension/chest pain patient, the FP would report malignant hypertension (such as 401.0, Essential hypertension; malignant), and the cardiologist would code the chest pain (for instance 786.59, Chest pain; other).  

-The different diagnoses and different specialties involved should facilitate payment of both claims,- says Kent J. Moore, manager of Health Care Financing and Delivery Systems for the American Academy of Family Physicians in Leawood, Kan.

99231-99233 Pays $10 More Than 99261-99263

Barring payment obstacles, 99261-99263's deletion will benefit your bottom line. -Level for level, subsequent care codes pay at a higher rate than follow-up consultation codes,- Callaway says.

Moneymaker: Codes 99231 and 99233 pay $11.75 more than 99261 and 99263, based on the 2005 National Physician Fee Schedule Relative Value File. Code 99232 reimburses $10.23 more than 99262.