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Thread: Consult/Initial Hosptial/Subsequent

  1. #1
    Join Date
    Apr 2007

    Smile Consult/Initial Hosptial/Subsequent

    AAPC: Back to School
    I have a question and it is somewhat related to a question I posted under this section. I know with consults you are to code an initial hospital visit (when in the hospital) and if the pt does not meet all criteria you move to a subsequent. Here is my confusion: Lets just say I have a pt that is a consult and I find the note to be Detailed History, Detailed Examination and Moderate MDM and I believe this would get a 99221. Correct? I have someone else saying that you would move it to a subsequent level visit b/c all three have to be exact. For example a Detailed history, Detailed exam and SF/L MDM. I am under the impression that you choose the code furthest to the left and if you fall short of any of those on the left you then would move to a subsequent visit code. This is where I question a new pt visit and I have a PF history, a Detailed exam and moderate MDM I would choose a 99201 but have been told that this is incorrect and you should choose an established visit that fits. Where do I find the documentation for the correct way? I have paged through 1997 and 1995 guidelines and haven't pinpointed it. Thanks!

  2. #2
    Join Date
    Apr 2007
    Columbia, MO


    You must meet OR EXCEED all three of the key components so yes you code to the lowest component. You are correct.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Join Date
    Apr 2007


    Thank you. I don't know why I keep questioning everything I do lately?! I had a dr come down on me lately for confusing a high risk pt for moderate risk pt on a note and ever since then I have myself in a darn tizzy!!

  4. #4
    Join Date
    Apr 2007
    Milwaukee WI

    Default Subsequent vs Unlisted E/M

    Please check with your carrier about what to code when you don't meet the three key elements for 99221. WPS has specifically instructed that we are to use the unlisted E/M 99499.

    Other carriers expect you to code the subsequent hospital visit codes: 99231-99233.

    If the patient is admitted to inpatient status in the hospital it makes no difference if they are new or established. The 99201-99205 codes are for new patient OFFICE visits - would not be used for an inpatient. Ditto 99211-99215 which are for established patient OFFICE visits.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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