Otolaryngology Coding Alert

Start bulletproofing your modifier 25 service documentation Throw away your notes on distinguishing follow-up consultations from initial consults--CPT 2006 eliminates this distinction.

The AMA released the tentative agenda for its CPT 2006 Coding Symposium, to be held Nov. 17 and 18 in Chicago. The agenda offers the first official clues as to which big coding changes you can look forward to next year. When the 2006 CPT updates take effect Jan. 1, 2006, otolaryngologists will face two major E/M changes. CPT 2006 will:

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

- clarify modifier 25's explanatory text to specify that documentation must support the significant and separate E/M claim.

Here's what the changes mean to you. Lump All Inpatient Consults as 99251-99255 This winter you won't have to question whether an inpatient consultation is an initial or follow-up consult--a distinction that otolaryngology coders have long struggled to comprehend. -Physicians never used the follow-up consultation codes correctly,- says Susan Callaway, CPC, CCS-P, an independent coding auditor and trainer in North Augusta, S.C.

New method: You-ll bill all inpatient consults as 99251-99255 (Initial inpatient consultation for a new or established patient -). Report follow-up inpatient care with subsequent hospital care codes 99231-99233 (Subsequent hospital care, per day, for the evaluation and management of a patient -). Replace Follow-up Consult With Subsequent Care Code
 
When an otolaryngologist receives a proper request for a consult in the inpatient setting, you may claim one initial inpatient consult (99251-99255) per hospital admission. These codes won't change for 2006. However, if the otolaryngologist sees the same patient during the same inpatient stay, you should report subsequent hospital care codes, not follow-up inpatient consult codes (99261-99263, which CPT 2006 will eliminate).

Example: After an otolaryngologist renders his opinion on a heart attack patient's sinusitis, the ENT continues to check on the patient during his hospital stay. -Because the ENT is managing the patient's subsequent sinusitis care, you should code the subsequent visits with 99231-99233,- Callaway says.

Current way: Suppose instead of managing the patient's sinusitis, the otolaryngologist only initially evaluates the inpatient and prescribes an antibiotic for him. Four days later, the cardiologist contacts the otolaryngologist and reports that the antibiotic is not working. Based on the cardiologist's request, the otolaryngologist sees the patient again to change the plan of care. You would currently report the second encounter as a follow-up inpatient consult (99261-99263). Next year, CPT will eliminate this option, so you will have to charge subsequent hospital care (99231-99233). Consider 99251-99255 per Hospital Admission A new hospitalization opens the door to another potential initial inpatient consult. When a physician discharges [...]