Wiki level 4 or 5 for IP Consult?

[wynonna]

Patient will be transferred to another hospital in surgical ICU for neuro embolization. (Decision made by hospitalist, not ENT)
Patient has Hemoptysis, pneumonia, confusion, tongue cancer.
ENT was called urgently for need for surgical intubation this morning. Upon exam the patient is stable and able to maintain his own airway.
Would this be High MDM under Number and complexity of problem addressed? (1 chronic illness with severe exacerbation or progression.)
Would this be High Risk for urgent transfer to another hospital?
If so, this would be 99205 for the ENT involvement?
thank you

 

[csperoni]

99205 is not an inpatient code.
Inpatient E/M is 99221-99223 and 99231-99233. Those codes are based on history, exam, and MDM (no change for 2021). The initial 99221-99223 require all 3. The subsequent 99231-99233 require 2 of 3. The levels of history, exam and MDM need to be assessed in order to code the E/M.
NOTE: You use the word consult in your question header, but this does not seem at all like a coding definition of consult. This has been a big problem over the years and while medical professionals may throw around the term consult, coders (in the context of coding) should only use it when they mean the coding definition of consult.

 

[wynonna]

Thanks for your input. I see your points. The "consults" are being requested by hospitalists who request specialists in ENT for patient bedside consult for say, epistaxis. This patient was either in ER overnight, or Observation. If we didn't admit to Observation status, I'm told we can't bill Obs. Codes. We code office visits rather than consults because patient's insurance doesn't cover consults. I'm told if patient is admitted and spends over 72 hours in the hospital then it is inpatient and our first visit is 99221-99223. Subsequent visits are 99231-99233. This may be a practice decision that varies by MD and specialists. Or it may be following the "2 midnight rule". thank you for your input.