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Thread: Inpatient hospital billing

  1. #1

    Default Inpatient hospital billing

    AAPC: Back to School
    We have a PA that does inpatient hospital billing, we have been using the the code sets of 99251-99255 for her intial visit and then 99231-99233 for the subsequent hospital care. She gets the referral to go see the patient, sees the patient, then calls the referring dr back with what she thinks should be the plan of action, to see if that is what the referring dr wants her to do, and then she does the treatment. My question is should she be billing the 99251-99255 for the first time she sees the patient or should she be billing the 99231-99232 code sets?

  2. #2


    We have a PA that sees patients as an inpatient and we bill 99251-99255 for the first visit. We get paid on these also.

  3. #3
    Join Date
    Apr 2007
    North Carolina


    It all boils down to the intent of the visit. If the physicians opinion is being sought, then a consult could be billed.

    The intent of a consultation service is that a physician or qualified NPP or other appropriate source is asking another physician or qualified NPP for advice, opinion, a recommendation, suggestion, direction, or counsel, etc. in evaluating or treating a patient because that individual has expertise in a specific medical area beyond the requesting professional’s knowledge

    A physician or qualified NPP consultant may initiate diagnostic services and treatment at the initial consultation service or subsequent visit. Ongoing management, following the initial consultation service by the consultant physician, shall not be reported with consultation service codes. These services shall be reported as subsequent visits for the appropriate place of service and level of service. Payment for a consultation service shall be made regardless of treatment initiation unless a transfer of care occurs.

    In the hospital setting, following the initial consultation service, the Subsequent Hospital Care codes (99231 – 99233) shall be reported for additional follow-up visits.


  4. #4
    Join Date
    Apr 2007
    Milwaukee WI

    Default Who is the referring physician?

    I may be entirely wrong in my interpretation of your scenario ... but it almost sounds as if the physician in whose office the PA works is the one sending the PA to see the patient. If so, then it's not a consult ... might be an admission, might be a subsequent visit.

    If, however, you have a request from a physician outside your practice (or outside your specialty) for a consultation and your PA is responding to that request, then I completely agree with Rebecca Woodward.

    F Tessa Bartels, CPC, CEMC

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