Orthopedic Coding Alert

Question: We are getting conflicting or impossible directions. We have been told that we cannot code for an inpatient consult (99251-99255) if we order tests or perform a procedure, yet we are also told that only one physician can code for attending physician care (99221-99223). So when a patient breaks a hip and is admitted by his primary care doctor and we are asked to see the patient for orthopedic care and surgery, can we code for the consult if we plan to operate?

Anonymous Indiana Subscriber

Answer: The short answer is yes, says Susan Callaway-Stradley, CPC, CCS-P, an independent coding consultant and educator in North Augusta, S.C. The orthopedic surgeon can bill for the inpatient consult (prior to the decision for surgery) using the appropriate CPT code in the range of 99251-99255. The only exception would be if the referring physician (in this case, the primary care physician) transferred the responsibility for the patients care before the initial consultation is completed. The performance of procedures or ordering of tests should not affect your ability to code a consultation. This is well defined in CPT and was recently clarified by Medicare. (Medicare Carriers Manual 15506 update, August 1999.)

Note: See page 19 of the March issue of Orthopedic Coding Alert, Coding Correctly for Transfer of Care vs. Consults Can Stave Off Auditors for more about how to be certain an interaction with a patient is recognized as a consultation in the lexicon of the Health Care Financing Administration.