• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below..
  • Important Note: We will be performing a scheduled maintenance on 1st November 2020. The site will be offline from 7:30PM (MT) till midnight. We apologize for any inconvenience this may cause.

Inpatient admission vs consult


Venice, FL
Best answers
Is it appropriate for a physician to dictate a hospital admission as a "history and physical" to satisfy the hospital requirements but bill it as a consult if all requirements are met?

Thanks for any input!



Louisville, KY
Best answers
Nope. If the Consult results with admission (and the provider creates that order for admission), then the charge is for an initial hospital visit.

See the guideline in the E/M section. I think there's something there on this matter.


Edwardsville, IL
Best answers
I always remember the 4 R's of Consultation:

In order to code as a consultation there has to be:
1. Request- consultations have to be requested from the treating doctor
2. Reason- reason for the consultation
3. Rendered- the services rendered need to be documented
4. Report- consultations include a report to the requesting doctor

This is just a simple way that we use to know when it is a consultation. As a rule of thumb, an established patient will not get a consultation from their own doctor.

As stated earlier, if you have an admission resulting from an office visit consultation then you would code for the admission. However, I would look closely at the guidelines to see if in this case you could actually code for an inpatient consultation.

However, as also stated earlier I don't believe that you can because there would not be hospital documentation of the request for consultation. I believe that this is one case in which the consulting doctor would just have to accept the admission code for reimbursement. Thankfully this doesn't occur that often.