Neurosurgery Coding Alert

Choose one initial consult per inpatient stay Just because your surgeon meets with a patient in the hospital at the request of another physician doesn't mean that you can report an inpatient consultation (CPT 99251 - 99263 ).

The solution? Check your place of service carefully. Here are full details on the four most important factors to keep in mind when considering inpatient consult codes.
 
1. Watch the Place of Service If you-re going to report an inpatient consultation, the patient your surgeon sees must have been admitted as an inpatient. Although this sounds obvious, mistakes occur all the time.

-Not all facility settings qualify as -inpatient,- - says Marvel J. Hammer, RN, CPC, CHCO, president of MJH Consulting in Denver. -You can easily make a mistake by thinking, -The doctor saw the patient in the hospital, so it must be an inpatient service.- But the ED [emergency department], for instance, is an outpatient setting, and doctors provide consultations in the ED all the time.-

Specifically, inpatients include patients admitted to hospitals or partial hospital settings, as well as nursing home residents.

Watch for: You should not use inpatient codes for patients the surgeon consults with in the ED, for patients designated -observation status,- or for residents of domiciliary, rest (boarding) homes, custodial care or other -nonskilled- facilities. 2. Claim an Initial Consult First If you-ve determined that the patient qualifies for inpatient status--and the available documentation supports a consultation (see -Billing a Consult?- at right)-- you should choose an appropriate-level initial inpatient consultation code (99251-99255) for the surgeon's first meeting with the patient.

Remember: -You can report 99251-99255 only once per patient per hospital stay,- says Michael A. Ferragamo, MD, FACS, clinical assistant professor at State University of New York, Stony Brook.
 
Example 1: The managing physician requests that the neurosurgeon provide a consultation for a bedridden hospital inpatient. The surgeon meets with the patient, conducts a full history and examination and diagnoses incapacitating sciatica caused by a displaced intervertebral disk (722.10 ). The neurosurgeon then prepares a report of his findings and shares them with the managing (requesting) physician.

In this case, you should report an initial inpatient consult (for instance, 99254, Initial inpatient consultation for a new or established patient ...).

Keep in mind: If the patient is discharged and later re-admitted to the hospital, you may report another initial consult, as long as you meet all the consult criteria.
 
Example 2: The patient in the above example leaves the hospital only to be re-admitted three days later. The managing physician once again requests a consult from the neurosurgeon because the patient shows new symptoms of neck pain. You may again report 99251-99255, as appropriate. 3. Same-Stay Consult Means Follow-up Code For the remainder [...]