Primary Care Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: Our family practice is in a small city. Often, our physicians visits patients and their families when they are hospitalized, even if our physician is not the attending physician. Is there an appropriate code to assign for this service? Kansas Subscriber Answer: It depends on the context of the visit. If the physician is simply stopping by as a courtesy, it is not appropriate to bill for the visit. However, a family physician (FP) may see a patient hospitalized by another service. One example may occur if the attending physician requests that the regular doctor see the patient, which should be coded and billed as a consultation (99251-99255 for initial, 99261-99263 for follow-up). For instance, an orthopedist may hospitalize a patient who has suffered a broken hip and leg during an auto accident and is in traction. During the hospitalization, the patient may develop a fever and sore throat. The orthopedist may request a consultation by the FP because he may not be comfortable diagnosing and treating these symptoms. The FP can sometimes bill for a confirmatory consultation (99271-99275). These codes are assigned when the patient or family member initiates the visit and asks for the physician's input regarding patient care and treatment. For instance, a 50-year-old woman has been a patient of Dr. White for 10 years. Dr. White referred the patient to a gynecologist when he found uterine growths. After the gynecologist performs a hysterectomy, the patient requests a confirmatory visit with Dr. White to discuss the gynecologist's recommendations for hormone-replacement therapy. Because the visit was initiated by the patient and included treatment decisions, it is appropriate to code a confirmatory consultation. FPs must document the patient's request and the topics discussed in the patient's record, and formally send documentation about the visit back to the attending physician.

In most cases, the FP would need to have privileges at the hospital where the confirmatory consultation occurred. However, if the FP does not have privileges, the visit may be documented in the patient's record kept in the practice's office with a notation that the service was provided at Hospital XXX.