Reader Question:
Discussion of Nutritional Supplement
Published on Thu Mar 01, 2001
Question: Our gastroenterologist spent 45 minutes in a discussion about a patients nutritional supplement, which the patient was receiving through a PEG tube. The gastroenterologist became involved when the floor nurse determined that the patient was not receiving enough nutrition. The nurse, a nutritionist and the primary care physician were also part of the discussion. What code should we use to report this service?
Ohio Subscriber
Answer: There is not a specific code for administering nutritional supplements, according to Pat Stout, CMT, CPC, an independent gastroenterology coding consultant and president of OneSource, a medical billing company in Knoxville, Tenn. Your question does not specify whether the gastroenterologist had face-to-face contact with the patient, but you might be able to bill an evaluation and management (E/M) service, depending on the nature of the gastroenterologists involvement and the other services provided.
To bill for an E/M service, the gastroenterologist must examine the patient directly, Stout says. If the discussion with the gastroenterologist took place over the telephone, no service can be billed. Often a primary care physician will call the gastroenterologist on the telephone and say, I have a patient on a nutritional supplement who is not thriving. What do you think? Although they may spend 45 minutes on the phone discussing the case, this is not a reimbursable service to the gastroenterologist because he or she did not see the patient, she explains.
If the primary care physician has requested the advice or opinion of the gastroenterologist, coders may bill an initial inpatient consultation (99251-99255) as long as the requirements for a consultation have been met. You can only bill for a consultation if the primary care physician specifically requests the gastroenterologists advice or opinion, explains Stout. That request should be noted in the patients shared medical record.
After the gastroenterologist has examined the patient at the request of the primary care physician, the gastroenterologist must report the findings back to the requesting physician, Stout says. For an inpatient consultation, the findings can be noted in the patients shared medical record.
If the primary care physician does not supply advice and/or an opinion and the encounter does not fulfill the requirements of a consultation, the gastroenterologist may report a subsequent hospital care service (99231-99233) as long as the key components for those codes are fulfilled.
The situation may change if the gastroenterologist performed the PEG tube placement. If the gastroenterologist, for example, did a nonendoscopic placement with the aid of fluoroscopy (43750) and the discussion takes place within the 10-day global period following the placement, no E/M service can be reported because it is considered part of the global package.
If the gastroenterologist performs an endoscopic PEG [...]
