Otolaryngology Coding Alert

AMA also clarifies what documentation you need for modifier 25 You now have fewer codes to choose from when your allergist provides consultations--but that doesn't mean you-ll see less reimbursement. You may actually see $10 to $12 more on each in-patient follow-up visit since CPT eliminated follow-up and confirmatory consultations.

Now that the CPT updates have taken effect, allergists face two major E/M changes. CPT 2006 did the following:

- deleted follow-up inpatient consultations (99261-99263, Follow-up inpatient consultation for an established patient ...) and confirmatory consultations (99271-99275, Confirmatory consultation for a new or established patient ...)

- clarified the explanatory text for modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to specify that documentation must support the significant and separate E/M claim. What You Report Instead Remember that you should be reporting all follow-up inpatient care with subsequent hospital care codes 99231-99233 (Subsequent hospital care, per day, for the evaluation and management of a patient ...), but the deletions don't change the way you report the physician's initial inpatient consults. Continue to bill those as 99251-99255 (Initial inpatient consultation for a new or established patient ...).

The elimination of the follow-up inpatient consultation codes makes coding of inpatient visits easier for physicians. -These codes were rarely used correctly and so put physicians at a good deal of risk when they were used,- says Marcella Bucknam, CPC, CCS, CPC-H, CCS-P, HIM program coordinator at Clarkson College in Omaha, Neb. And carriers rarely reimbursed appropriately, and many insurers did not reimburse at all for follow-up consultations, Bucknam adds.

How it works: When your allergist receives a request for a consult in the inpatient setting, you may claim an initial inpatient consult (99251-99255) for the visit. If your physician sees the same patient during the same inpatient stay, you should report subsequent hospital care codes (99231-99233), not follow-up inpatient consult codes (99261-99263) as you would have in 2005.

Example: A physician asks your allergist to see a newly hospitalized 13-month-old patient with a spasmodic cough, respiratory distress, and fever. Your allergist diagnoses extrinsic asthma with acute exacerbation (493.02) and pneumococcal pneumonia (481).

The allergist starts the patient on antibiotics and nebulizer treatments. Four days later, the attending physician asks your allergist to see the patient again to recheck and to arrange nebulizer treatments at home, as well as complete an allergy workup when the patient completely recovers.

You should charge an appropriate level of consult for the first visit (99251-99255) and a subsequent hospital care code (99231-99233) for the second visit.

Use ICD-9 code 493.02 (Extrinsic asthma, with exacerbation) for the asthma diagnosis, and use 481 (Pneumococcal pneumonia) for the pneumonia diagnosis. Deletions Increase Pay but [...]