Wiki Subsequent outpatient consult coding

[hannxelizabeth]

Hi everyone,

I have a patient who was seen in the hospital by one of our physicians and we billed 99218 for initial consultation. The patient was also seen in consultation by the doctor the next day in the hospital as outpatient but was never admitted. Would I use 99225? I'm new to professional hospital E/M coding.

Thank you!

 

[Janet Fairhurst]

You are using the Initial observation care code set (99218-99220). Yet you are saying "consultation". If it was truly a "consultation" (the opinion was requested by another provider) then the code set would be 99241-99245. If your provider admitted the pt to observation then the code set would be 99218-99220. The subsequent day for your doc would be 99224-99226 depending on the level of service documented.

Only one consultation code per provider during the stay is allowed, if the same physician sees the pt after that it is a subsequent encounter. This is true for inpt admissions and I believe it would be the same for observation status.

I hope this helps