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Inpatient consult.

  1. #1
    Default Inpatient consult.
    Medical Coding Books
    If the referring physician isn't documented for an initial inpatient consultation-
    Can you code it as an initial inpatient visit instead?
    99255 vs 99223

  2. #2
    Location
    Sarasota FL
    Posts
    1,067
    Default
    Quote Originally Posted by smalldetails View Post
    If the referring physician isn't documented for an initial inpatient consultation-
    Can you code it as an initial inpatient visit instead?
    99255 vs 99223
    .

    No you can't. If it is a commercial insurance that still accepts consult codes, you must bill an IP consult code, with a referring provider documented. No matter how bad the documentation, you will be able to code it to 99251-99255. You can only bill an initial visit(I presume you mean an H&P) if your provider is the admitting.
    You cannot bill an H&P just to give your provider more money, or just so you don't have to communicate with the provider to add the referring to the documentation.
    I would class that as fraud(intent to obtain pecuniary advantage knowing that it is wrong).
    Do you look good in orange?

  3. Default
    My opinion :- The "RRR" will need to match for consultation code. If the insurance was commercial bill with 99251-99255. If it is a Medicare, need to bill with initial inpatient visit ( 99221-99223) as per guideline.

  4. #4
    Default
    Wassock...

    You missed the question all together.
    Referring physician info is missing altogether.
    No need for you to be so rude.

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