Urology Coding Alert

Question: If my urologist sees a patient in office for say BPH, then he is admitted for something else, and the admitting physician consults my urologist for BPH, is it a new consult?Alabama Subscriber

Answer: In this case the coding would depend on the payer’s consultation rules.

If following Medicare rules, in-hospital consultations are billed with the initial hospital visit code 99221-99223 (Initial hospital care, per day, for the evaluation and management of a patient …) whether the patient is old or new.

The same holds true if the payer follows CPT® rules. In-hospital consultations would be billed with the older CPT® codes 99251-99255 (Inpatient consultation for a new or established patient …) whether the patient is a new or old patient.

All this assumes that consultation requirements are met. If there is no consultation requested, and the admitting physician only wishes the urologist to also follow the patient in the urologist’s case for the known BPH, and no formal request has been made by the admitting physician for the urologist’s opinion, you should report a follow-up hospital care code from 99231-99233 (Subsequent hospital care, per day, for the evaluation and management of a patient …).

In the office for Medicare if a consultation is requested for this same patient, the urologist should bill an established patient code (99212-99215, Office or other outpatient visit for the evaluation and management of an established patient …), as this patient in your scenario is not a new patient but was treated by the urologist during the last three years. However, following CPT® rules, you may code a consultation in the office with 99241-99245 (Office consultation for a new or established patient …).