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Thread: Inpatient Consultations - I work in a Family Practice

  1. #1
    Join Date
    Apr 2007

    Unhappy Inpatient Consultations - I work in a Family Practice

    AAPC: Back to School
    I work in a Family Practice office but two of our providers see patients at the hospital. I am not to familiar with inpatient billing and the providers are billing several inpatient consultations in a row example: 01/10/09 99254 then on 01/12/09 99253... Can the same provider bill multiple consultations for one single admission?

  2. #2

    Default Inpatient Consultations

    Each inpatient stay allows one consultation per specialty. Who is the admitting physician? Is the admitting physician also Family Practice. In the physician orders what exactly does the order state is the reason for the consultation?
    What I am finding when I review the inpatient consultations, which includes the actual orders in the chart, it they are not really consultations. The referring physician/admitting physician is wanting the Family Med/Internal Med physician to "manage" the co-morbidities for that patient.

    This all goes back to the orders and what the requesting physician states is their intent. Whether you meet the three "R's" for a consultation really does not matter if the intent is transfer of care for management of co-morbid conditions. The admitting physician is usually not wanting the "advice or opinion" relayed back to them for them to make the treatment decisions. The admitting wants to handle the surgical condition or what ever condition they admit for. They want a general practitioner to manage the other conditions.

    CPT states that additional (subsequent) visits should be billed as subsequent visits following a true consultation. CPT deleted the follow up consultation codes a few years ago.

  3. #3
    Join Date
    Apr 2007

    Default inpatient consults on established patients

    What if an inpatient consultation is requested on a patient who is already established with our practice, can that be billed with the inpatient consultation codes or should we be using subsequent codes.

  4. #4
    Join Date
    Apr 2007
    North Carolina


    Yes. If your physician's opinion is being sought, he can bill for the consultation.

    "The Initial Inpatient Consultation may be reported only once per consultant per patient per facility admission."

    Keep in mind that consultations are not based by new versus established patient.



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