Pulmonology Coding Alert

Question: If a patient is repeatedly readmitted to the hospital for acute COPD by her primary-care physician, and I'm consulted on each admission, how should I report that -- as a follow-up visit or consultation each time? Also, is that affected if I see the patient in the office in between hospitalizations?

Utah Subscriber

Answer: You can report initial inpatient consultations once per admission. When the primary-care physician requests the pulmonologist's opinion/advice regarding a particular issue, and all of the criteria for a consultation are met, report the most appropriate code from 99251-99255 (Initial inpatient consultation for a new or established patient ...).
 
Each time the patient is hospitalized, the pulmonologist's opinion/advice may be medically indicated because the patient's condition and plan of care will vary from that established in the outpatient setting. If the pulmonologist must see the patient subsequent to the initial consult, you may use only the subsequent hospital care codes (99231-99233, Subsequent hospital care, per day, for the evaluation and management of a patient ...) for the follow-up visits.
 
Tip: Be sure the primary-care physician documents the request for consultation in the hospital chart. If the documentation is not in the chart, you should not report a consultation code.