Urology Coding Alert

Question: When a urologist performs an inpatient consult, I bill CPT 99251-CPT 99255. Should I code a follow-up visit with 99261-99263 or 99231-99233?

Illinois Subscriber Answer: You actually have two code choices for a hospital visit following an initial inpatient consultation (99251-99255, Initial inpatient consultation for a new or established patient ...). Depending on the situation, you may report either a follow-up inpatient consultation (99261-99263, Follow-up inpatient consultation for an established patient ...) or subsequent hospital care (99231-99233, Subsequent hospital care, per day, for the evaluation and management of a patient ...).

Use 99261-99263 when:
 1. The attending physician requests a subsequent consultative visit from your urologist, and
 2. Your urologist performs the follow-up visit to complete the initial consultation. Alternative: When your urologist assumes patient care, you should assign 99231-99233. So if the urologist initiated treatment at the initial consultation and thereafter participated in the patient's management, you should report a code for subsequent hospital care, not a code for  follow-up inpatient consultation.

Documentation tip: Unlike an outpatient consultation (99241-99245, Office consultation for a new or established patient ...), 99261-99263 don't require your urologist to send a written report to the attending physician. The doctors should record the request, review and report in the patient's shared medical chart.

Warning: Codes 99261-99263 will be valid in 2005 but most likely will be discontinued in 2006. Follow-up hospital consultation codes also pay less, level for level (by $10 to $15) than codes 99231-99233. Therefore, most urologists will bill subsequent hospital visits when following a patient in hospital after an initial hospital consultation. - Answers to Reader Questions and You Be the Coder contributed by Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook; and Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 31-urologist practice in Indianapolis.