Otolaryngology Coding Alert

You can't report a consult if the patient requests the service

Because CPT 2006 deletes follow-up inpatient (99261-99263) and confirmatory (99271-99275) consults, you must claim all same-stay inpatient follow-ups using subsequent care codes 99231-99233 (hospital) or 99307-99310 (nursing facility)--depending on the site of service--according to new-for-2006 CPT guidelines, says Suzan Hvizdash, BSJ, CPC, physician education specialist for the department of surgery at UPMC Presbyterian-Shadyside in Pittsburgh.

But you may still claim initial inpatient consults (99251-99255) for the first consult your ENT provides per inpatient stay, Hvizdash says.

Likewise, CPT 2006 deleted 99271-99275. For so-called -second (or third) opinions,- you should access -the appropriate E/M service code for the setting and type of service,- such as an office visit (99201-99215) or consult (99241-99255), CPT states.

A patient-generated -consult,- isn-t: A consult must come from -an appropriate source,- which does not include the patient or patient's family. An E/M service requested by the patient or patient's family -and not requested by a physician, is not reported using the consultation codes but may be reported using the office visit codes, as appropriate,- as outlined by CPT 2006.

As in previous years, however, if a payer mandates the E/M service for a second or third opinion, you should append modifier 32 (Mandated services) to the appropriate E/M service code.

Learn more: For complete information on changes to consult coding in CPT 2006, see -CPT Rings in the New Year With Streamlined Consultation Coding- on page 73 of the October 2005 Otolaryngology Coding Alert.