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Orthopedic Coding Alert

Say Goodbye to Confirmatory Consult Codes in 2006

CPT will revamp consult coding next year You can forget the rules you learned about distinguishing follow-up consultations from initial consults--CPT 2006 will most likely eliminate this distinction.

The AMA released the tentative agenda for its CPT 2006 Coding Symposium, to be held Nov. 17 and 18 in Chicago. The agenda gives the first official clues as to which areas next year's coding changes will address.

When the 2006 CPT updates take effect Jan. 1, 2006, orthopedic surgeons will face two major E/M changes. CPT 2006 will:

- delete follow-up inpatient consultations (99261-99263, Follow-up inpatient consultation for an established patient -) and confirmatory consultation codes 99271-99275 (Confirmatory consultation for a new or established patient -)

- clarify modifier 25's explanatory text to specify that  documentation must support the significant and separate E/M claim.

Here's what the changes mean to you. Bill All Inpatient Consults as 99251-99255 This winter, you won't have to question whether an inpatient consultation is an initial or follow-up consult--a distinction that orthopedic surgery coders have long struggled to comprehend.
-Physicians never used the follow-up consultation codes correctly,- says Susan Callaway, CPC, CCS-P, an independent coding auditor and trainer in North Augusta, S.C.

New method: You-ll bill all inpatient consults as 99251-99255 (Initial inpatient consultation for a new or established patient -). Report follow-up inpatient care with subsequent hospital care codes 99231-99233 (Subsequent hospital care, per day, for the evaluation and management of a patient -).

How it works: When an orthopedic surgeon receives a proper request for a consult in the inpatient setting, you may claim one initial inpatient consult (99251-99255) per visit. These codes won't change for 2006. However, if the surgeon sees the same patient during the same inpatient stay, you should report subsequent hospital care codes, not follow-up inpatient consult codes (99261-99263, which CPT 2006 will eliminate).

Example: After an orthopedic surgeon renders his opinion on a heart-attack patient's hip tendinitis, the physician continues to check on the patient during his hospital stay. Because the orthopedic surgeon is managing the patient's subsequent tendinitis care, you should code the subsequent visits with 99231-99233. Use Right Diagnoses to Capture Dual E/Ms Pay attention to diagnostic coding to help you avoid denials for two same-day, E/M services that different specialists perform.

In the above subsequent care scenario involving the tendinitis/heart-attack patient, each specialist should report subsequent hospital care (99231-99233). Therefore, the insurer will receive two subsequent hospital care claims for the same patient on the same date of service.

Key: Each specialist must report the condition(s) he cares for to ensure multiple subsequent visits do not cause denials for concurrent care. -ICD-9 instructs the physician to list all of the diagnoses he or she addressed during that exam,- Callaway says.

For the tendinitis/heart-attack patient, the orthopedic [...]

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