Practice Management Alert

Double-Check Your Inpatient Codes to Avoid OIG Scrutiny

Do you report a string of follow-up consultations instead of subsequent hospital care? The HHS Office of the Inspector General is watching. Use the following tips and scenarios to make sure you report these services correctly:

-- Watch out: If your consulting physician sees an inpatient more than once after the initial consult, chances are good that he has assumed responsibility for a portion of the patient's care and should report subsequent hospital care codes (99231-99233) instead of follow-up inpatient consultation codes (99261-99263).

-- Read the chart carefully to determine whether the physician is managing the patient's care or remaining in a consultative role, says Curtis J. Udell, CPAR, CPC, CMPA, senior advisor at Health Care Advisors Inc. in Annandale, Va.

-- Scenario #1: Your physician renders a requested consultation to an inpatient and completes the necessary reports and treatment that day. She then returns the following day to check the patient's progress and make additional changes to the plan of care.

-- You code: Subsequent hospital care. The physician's second visit indicates she now manages the care of the patient's condition.

-- Scenario #2: Your physician visits a patient late in the day to render a requested consultation. He orders some tests and returns the next day to read the results and complete the consultation.

-- You code: Follow-up consultation. The physician's consultation services have simply carried over to the next day to complete the total consult. However, if the physician continues to manage care, start billing subsequent hospital care codes.