Gastroenterology Coding Alert

When your gastroenterologist sees a Medicare inpatient and would have used an inpatient consultation code, this year you should report an initial hospital care code 99221-99223 (Initial hospital care, per day, for the evaluation and management of a patient ...). If the E/M service and documentation do not meet the requirements of an initial inpatient hospital care code, however, your coding will now depend on your Medicare Administrative Contractor's (MAC) or carrier's policy. Problem: The lowest initial hospital care code (99221) requires a detailed history and detailed exam. When your gastroenterologist's documentation does not reach this level, there is a question as to what CPT codes you should use. At the beginning of the year some MACs/carriers stated that you should use the subsequent hospital care codes (99231-99233). "Our MAC (Highmark) has actually stated to not use 99499 (Unlisted evaluation and management service) for consultations and to use subsequent care [...]