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Orthopedic Coding Alert

Reader Questions:

2 Admissions May Mean 2 Initial Consult Codes

Question: Our surgeon performed an inpatient consult for a car-accident patient. He discharged the patient, but five days later the patient's internist admitted the same patient into the hospital for back pain unrelated to the car accident. The second admitting physician also called our surgeon for another consult with this patient. Should we charge for a follow-up consultation for the second visit, or should we charge for another initial inpatient consult?


Tennessee Subscriber
Answer: According to CPT, you can report an initial inpatient consultation code (99251-99255) once per inpatient admission if your physician meets the consultation criteria. Therefore, your orthopedic surgeon can bill an initial inpatient consult code during each of the patient's two admissions.

In contrast, you should use a follow-up inpatient consultation code (99261-99263) when the surgeon provides any additional consults during the same hospital stay.

For example, if the surgeon performed a consult on day one of the patient's stay, and a second consult (at the attending physician's request) on day six, you would report the first visit using an inpatient consult code, and report the second visit using a follow-up consultation code.

Remember that the orthopedist should document the request for his opinion, notes from his review of the patient, and his report back to the requesting physician.

CMS recently issued a "Medlearn Matters" article that advises practices how to properly bill consultations. To read the article, visit the CMS Web site at www.cms.hhs.gov/medlearn/matters/mmarticles/2005/SE0515.pdf.


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