Otolaryngology Coding Alert

Question: Our otolaryngologist consulted a plastic surgeon on a patient who sustained facial fractures in a fall. The patient was transferred to the care of the plastic surgeon, who repaired the fractures. The plastic surgeon then consulted our otolaryngologist on a different matter (trach management) during the same hospitalization. Considering the plastic surgeon (not our otolaryngologist) requested the trach management consult, should we bill the consult as 9925x, 9926x or 9923x?

Minnesota Subscriber
 
Answer: The E/M section of CPT 2002 states, Only one initial consultation should be reported by a consultant per admission. In this case, 9925x (initial inpatient consultations) should not be reported since the otolaryngologists earlier consultation (for the facial fractures) took place during the same admission. Since the plastic surgeon requested the otolaryngologists opinion and assuming the other criteria for a consult were met, the otolaryngologists second encounter with the patient for a new problem (trach management) should be billed as a follow-up consult (9926x) and not subsequent hospital care (9923x). If the otolaryngologists opinion had been requested regarding the facial fractures, however, a consult could not be billed and subsequent hospital care would have to be reported. Had the patient been discharged following facial fractures repair and then readmitted for trach management, another initial inpatient consult could have been reported.