Gastroenterology Coding Alert

Thinking that they might be missing out on some extra reimbursement, several gastroenterologists have asked Gastroenterology Coding Alert about the proper use of followup inpatient consultation codes (99261-99263) and whether those codes should be used instead of subsequent hospital care codes (99231-99233).

Although there are specific instances when the followup inpatient consultation codes should be used, gastroenterologists who are tempted to substitute these codes for a subsequent care code should be aware that followup consults have a lower level of reimbursement.

Gastroenterologists often dont have a clear understanding of why or when to use these codes, says Pat Stout, CMT, CPC, an independent gastroenterology coding consultant from Knoxville, Tenn.

Defining Subsequent Consultations

A followup inpatient consultation code may be reported when a gastroenterologist is called by another physician to perform a subsequent consultation on a patient. For example, a patient who is admitted to the hospital because of uncontrolled diabetes develops unexplained jaundice, Stout says. After examining the patient and running some tests, the admitting physician calls a gastroenterologist for a consultation. After the gastroenterologist conducts his or her examination, an endoscopic retrograde cholangiopancreatography (ERCP) is performed, but no stones are found that might be causing the patients jaundice. The patients symptoms and jaundice appear to improve, and the gastroenterologist signs off on the patient. Several days later the patient, who still has uncontrolled diabetes, becomes jaundiced again, and his or her blood chemistries are elevated. Again, the attending physician calls the gastroenterologist for a consultation, which should then be billed as a followup consultation.

Defining a Complete Initial Consult

The followup consultation codes can also be used to complete an initial consultation with a patient, according to Stephanie Jones, CPC, a multispecialty coding consultant in Boca Rotan, Fla. These codes were designed to be used when a physician is asked to come in for an opinion, she says. The physician takes a history, does a physical examination and some medical decision-making, such as ordering a test, but cant render an opinion until the results of the test are back.

If no opinion can be rendered, Jones continues, the physician needs to note in the patients shared medical record that a followup is required at this time.

The gastroenterologist cannot use the followup consultation as a session to review the test results with the patient. Two of the three key components of an evaluation and management (E/M) service must also occur and be documented in the patients medical record for this to be considered a consultation. The gastroenterologist must be face-to-face with the patient and take a separate history, and perform a separate physical examination and medical decision-making before this can be billed as a followup consultation, [...]