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charges for hospital stay

heathermc

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Currently, when another doctor admits a pt. and we do a consult and the next day or subsequent day we preform surgery, we code the consult as 99251/99252, BUT now our billing manager is questioning that. If we are taking over the care of the pt. and preforming the surgery, should the consult be coded as a subsequent day E/M? or what code should be used if a consult code is not acceptable. Reason being, a consult must include the 3 R's, but not take over the full care of the patient.
 
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4,466
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Milwaukee WI
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May still be a consult

Heather,
A consultant MAY initiate diagnostic tests or treatment as a result of the consultation. Please look at the guidelines in CPC. (I'm at home and don't have my book with me or I'd quote it for you.)

If the initial visit truly meets the requirements for a consultation, then it is a consult and you would append the -57 modifier if it is also the decision for surgery (and that surgery will be within a couple of days of the consultation visit).

F Tessa Bartels, CPC, CPC-E/M
 

crhunt78

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Olathe, KS
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I agree with Tessa. If it meets the requirements, it should be coded as a consult. Maybe you should take the consult guidelines in the CPT book to your billing manager. Do an audit on a couple of the visits to make sure that the doctors are dictating consults and take it to your manager.
 
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