Wiki 99221 or 99231 for IP consult

[wynonna]

Hx is detailed
Exam is detailed
MDM is low complexity
If a patient came to see one of our MD's in our office for a pre-op /Hx and Physical a week before surgery, and our MD later sees patient in IP hospital, do we bill a 99221-for initial visit or 99231 for subsequent hospital care?

 

[cgaston]

The hopsital inpatient codes are not impacted by whether or not the pateint is a new patient to the doctor, they are selected based on what type of encouter it is for the hospital stay. If it is the first visit with the patient during the inpatient stay you select from the 99221-99223 codes. If it is a subsequent visit during the inpatient stay you select from 99231-99233.

You may or may not be able to bill for a separate E&M visit after a surgery, though. It will depend on if the surgery has a global period and whether or not the visit is unrelated to the surgery.

 

[Orthocoderpgu]

Hx is detailed
Exam is detailed
MDM is low complexity
If a patient came to see one of our MD's in our office for a pre-op /Hx and Physical a week before surgery, and our MD later sees patient in IP hospital, do we bill a 99221-for initial visit or 99231 for subsequent hospital care?

Something seems a bit off here. The patient is being seen for a "pre-op" visit. Pre-op visits are included in the surgical procedure and are not billable by the surgeon. If your physician needs to see the patient at the surgeon's request to clear them for surgery due to a specific medical condition, it can be billed.

If the patient being seen is not formally admitted to the hospital as an "Inpatient" patient, then billing the visit as an inpatient service would be incongruent.

Lastly, be careful with the word "Consultation". CMS audited "consultations" for three years and 95% of the time the documentation did not support the code because one of the three R's was missing (Request, Render, Report) which is why CMS and now many private insurance companies don't pay for the consultation codes any longer.