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Thread: Consults again

  1. #1
    Join Date
    Apr 2007

    Default Consults again

    AAPC: Back to School
    Ok here is the senario a medicare patient comes in with a fracture to the leg. Dr. A who is surgery admits the patient and uses the AI modifier. Dr. B who is an ortho does an inpatient consult and bills 99223. Several weeks later the patient is admitted to surgery again, different dx, Dr A does another admit with AI modifier and Dr. B is consulted again, different dx, would Dr. B bill this as an initial visit or subsequent since the patient is not new to him but does present with a new problem ?? Thank you

  2. #2
    Join Date
    Apr 2007
    St. Louis, Missouri


    The initial hospital visit codes are for new and established patients. I would bill the initial hospital visit for Dr. B again because this is his/her initial visit with the patient during this hospital stay.

    Melissa Blow, CPC

  3. #3
    Join Date
    Apr 2007
    Mesa, AZ


    Yes, you can bill another intital visit code 99221-99223.
    Jill Tom, COC, CPC, CPMA, CPC-I
    East Valley Kachina Coders
    East Valley Mesa, AZ AAPC Local Chapter
    President 2011
    President-Elect 2010
    New Member Development Officer 2009

  4. #4
    Join Date
    Apr 2007


    would anyone have any documentation stating that ?? I have serveral articles but they only state to code the consult as an initial visit, nothing about if they are consulted again on the next admission.

  5. #5
    Join Date
    Apr 2007

    Default It is per admit, not per patient

    Each new provider can charge an initial inpatient for every admit (as long as they meet the requirements of the code).

    There is no limit, as long as it is a separate admit and someone else in your group/specialty has not already seen them in this admit, you charge the initial if your documentation supports it. If not, you charge a subsequent.

    The SE1010 MLN supports using the subsequent when documentation is not supportive of an initial. I don't have any links handy but I'm pretty sure everything is referred to as a per admit basis, it always was in the past. With consults you were only allowed one consult per admit even if you were called back for a different issue.

    Laura, CPC, CPMA, CEMC

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