Inpatient Facility Coding & Compliance Alert

Answer: Because this is an inpatient consultation by your physician, you would use the appropriate level from the 99251-99255 (Inpatient consultation for a new or established patient …) range. The appropriate level depends on the level of the history, examination, medical decision making (MDM), and/or time she spent in the room during the operation. Often an exam and history are fairly limited for these types of consultations.

 

In this situation coding by time can be very useful. The consulting physician will have to report the total time and then indicate that more than 50 percent of the time was spent counseling. Most likely the entire service is consulting to the operating surgeon.

 

The documentation your provider keeps is important because if she doesn’t put a note in the patient’s file that she walked into the operating room, the consult won’t be billable.

 

Tip: When the provider requesting the consult shares a common medical record, a separate report sent to the requesting provider isn’t necessary. However, the note should indicate who requested the consultation and why. Report only one initial inpatient consult per inpatient stay.

 

You will have to code differently if your payer follows CMS, which no longer recognizes consultation codes.

 

Alternative: If your payer doesn’t accept 99251-99255, you should use 99221-99223 (Initial hospital care, per day, for the evaluation and management of a patient …) or 99231-99233 (Subsequent hospital care, per day, for the evaluation and management of a patient…).