Gastroenterology Coding Alert

Question: An on-call physician treated one of our patients. The next day, our doctor took over service for the patient. Should I charge for consultation and follow-ups or daily visits? Will I need to append a modifier?
 
Vermont Subscriber

 
Answer: To answer this question, you first have to determine if another doctor asked your physician to consult on this patient. Second, determine how best to code for the care delivered by your gastroenterologist. Finally, determine what to do about the discharge.
 

Determine if the physician met the requirements for a consultation. To report a consultation code, you need to know if the admitting physician requested a consultation from your gastroenterologist.
 

Remember the CPT five-point summary of consultation requirements:
 1. A consultation is an E/M service provided by a physician whose opinion and/or advice regarding evaluation and/or management of a specific problem is requested by another physician or other appropriate source.
 2. The request and need for the consultation must be documented in the patient's medical record.
 3. The consultant's opinion and any services ordered or performed must be documented in the patient's medical record.
 4. A physician consultant may initiate diagnostic and/or therapeutic services at the same or a subsequent visit.
 5. The consulting physician must communicate his or her opinion and/or advice to the requesting physician or other appropriate source by written report.
 
If the consultation documentation is in place, you can code for the E/M services with the appropriate level of initial inpatient consultation (99251-99255, Initial inpatient consultation for a new or established patient, which requires these three key components ...).
 
If your physician did not provide an initial inpatient consultation and accepted the transfer of the patient's care, you should report a subsequent hospital care code (99231-99233).

 
Regardless of whether you can code for a consultation, you'll be using codes 99231-99233, depending on the level of service provided, for the gastroenterologist's ongoing care.
 
The factors that determine which specific subsequent hospital code you should report are interval history, examination, and medical decision-making. CPT outlines the specific requirements that allow for each of the three codes.
 
Note: If you bill for the consultation, code that service on the day your physician delivers it. Use the subsequent hospital codes for the next day through the end of the patient's visit. If you do not code for initial inpatient consultation, use the 99231-99233 from the first day of service.

 
If your physician assumes the full management of the patient's care, you will also be eligible to bill for discharge services. Make sure that the initial admitting physician transferring full management care of the patient and your gastroenterologist note this in the patient's chart. You will report 99238 or 99239 (Hospital discharge day management), based on the length of time your physician takes to conduct the discharge.