Neurosurgery Coding Alert

Question: When the surgeon performs an inpatient consult, I bill 99251-99255. Should I code a follow-up visit with 99261-99263 or 99231-99233?

Illinois Subscriber Answer: You actually have two code choices for a hospital visit following an initial inpatient consultation (99251-99255, Initial inpatient consultation for a new or established patient ...).
 
Depending on the situation, you may report either a follow-up inpatient consultation (99261-99263, Follow-up inpatient consultation for an established patient ...) or subsequent hospital care (99231-99233, Subsequent hospital care, per day, for the evaluation and management of a patient ...).
 
Use 99261-99263 when:
 
1. the attending physician requests a subsequent consultative visit from the surgeon (which includes the same elements of medical necessity and communicated opinion as an initial consultation)
 
2. the surgeon performs the follow-up visit to complete the initial consultation, for example, when a final opinion cannot be rendered without assessing the results of tests ordered at the initial consultation. On the other hand, if the surgeon assumes patient care, you should assign 99231-99233. Therefore, if the surgeon initiated treatment at the initial consultation and thereafter participated in the patient's management, you should report a subsequent hospital care code, not a code for follow-up inpatient consultation.
 
Payers will usually pay for such "concurrent care" when both doctors are following a patient for different reasons, but not if they are both treating a single diagnosis.