Cardiology Coding Alert

Question: If my cardiologist sees a patient in January at the hospital and provides a consult, then the patient returns to the hospital six weeks later and the treating physician asks for another consult, should we bill this as a consult as well? Does it matter if the diagnosis is the same?

Tennessee Subscriber

Answer: The rule for inpatient consultations is that the physician may bill a consultation only once per hospitalization (99251-99255, Inpatient consultation for a new or established patient).

If this patient was still in the hospital six weeks later without a discharge in between, the physician may bill the second one as only subsequent inpatient care (99231-99233, Subsequent hospital care, per day, for the evaluation and management of a patient). If he provided the second consult after the patient was discharged and then re-admitted, he could again bill for the service using the inpatient consultation code (99251-99255).