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Thread: Inpatient Consult for Established patient

  1. #1

    Question Inpatient Consult for Established patient

    AAPC: Back to School
    i am researching whether or not i can charge an inpatient consult (99255), for an established office patient that has not been seen in the last 12-18 months in the office. Request to see patient from attending physician, diagnosis the same from last senn in office.
    I am particularly interested in the "3 year rule" with same diagnosis applies to this scenario.

    Thank you the HEM/ONC BLONDES

  2. #2
    Join Date
    Apr 2007
    Grand Rapids, MI


    IP consults can be done on New or Established patients providing the requirements are met for a consult and your payer is still paying for them. Otherwise, you will bill for an Initial Day. It clearly states that in the CPT book. Hope that helps.

  3. #3
    Join Date
    Apr 2007
    Bettendorf, Iowa


    Most of the payers in our area no longer accept consult codes so we would bill for an inpatient initial. Our medicare carrier requires modifier AI if our physician is the admitting also.
    Ruth Long CPC,CHONC

  4. #4


    thank you for your comments.

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