Pulmonology Coding Alert

Question: If a physician asks you to take care of his patient postoperatively, do you bill a consult 99241-99245?

George Sample, MD, FCCP
Washington Hospital Center
Washington, D.C.

Answer: No. If youre asked to take care of a patient, postoperatively, then the patients care is being transferred to you. You cannot bill the CPT consult codes, 99251-99255. To be asked to assume part of the care is a transfer of subsequent hospital care.
CPT states that subsequent hospital care includes reviewing the medical record, the results of diagnostic studies and changes in the patients status, (i.e., changes in history, physical condition and response to management) since the last assessment by the physician. Remember, subsequent hospital care (99231-99233) also includes evaluation and management of a patient, which requires at least of the three key components (history, examination, and medical-decision). These elements vary based on the code chosen. For instance, 99231 requires:

A detailed interval history;
An expanded problem-focused examination; and
Medical-decision making of moderate complexity.
Again, if youre being asked to see the patient for post-op management, youre being referred the patient and you should be billing daily subsequent hospital care visits (99231-99233).