Orthopedic Coding Alert

Remember, you should report only one inpatient consultation per inpatient stay. If the surgeon provides a consult service during a different inpatient stay (whether for the same or a different problem), you may report another inpatient consult code.

Example: The surgeon performs an inpatient consult on Jan. 2, and the patient is discharged the next day. The following week, the patient is admitted to the hospital again.

Once again, the orthopedic surgeon is asked by the primary-care physician to provide an opinion on the patient's condition. As long as the service meets the necessary requirements for a consult (that is, the surgeon renders an opinion and reports this back to the requesting physician without assuming care of the patient), you may again report the appropriate inpatient consult code for the encounter.

If the -consulting- doctor begins treatment or otherwise assumes responsibility for management of even a portion of the patient's condition prior to completing the visit, you cannot claim a consultation service. Instead, you should report -the appropriate evaluation and management service code for the site of service,- according to text added to CPT 2007.

Keep in mind: The consulting physician can initiate diagnostic or therapeutic services (which are often necessary to form an opinion) and still claim a consultation, but he must return responsibility for treatment to the requesting physician. The -consulting- physician may assume responsibility for the patient's care during a subsequent visit, but if he assumes care during the initial visit, you cannot claim a consult.