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Barbara Posted Wed 04th of October, 2017 15:18:29 PM
for a medicare pt if you are called in for an inpatient consult and of course we cant bill a consult code, would we bill 99221? Even though this code states for admitting doctor, we are not the admitting doctor, however, the patient would be a new patient to us and a first visit in the hospital. We are unaware if another Dr billed 99221-A1 We are very confused.
SuperCoder Answered Thu 05th of October, 2017 04:48:09 AM


Consultation is a type of evaluation and management service provided at the request of another physician or appropriate source to either recommend care for a specific condition or problem or to determine whether to accept responsibility for ongoing management of the patient's entire care or for the care of a specific condition or problem. A physician consultant may initiate diagnostic and/or therapeutic services at the same or subsequent visit.

Since you were called for inpatient consultation, so bill from the CPT code series 99251-99255.

These codes are used to report physician or other qualified health care professional consultations provided to hospital inpatients, residents of nursing facilities, or patients in a partial hospital setting. Only one consultation should be reported by a consultant per admission.

The written or verbal request for consult may be made by a physician or other appropriate source and documented in the patient's medical record by either the consulting or requesting physician or appropriate source. The consultant's opinion and any services that were ordered or performed must also be documented in the patient's medical record and communicated by written report to the requesting physician or other appropriate source.

If a consultation is mandated (eg, by a third-party payer) modifier 32 should also be reported along with the CPT code.

Barbara Posted Thu 05th of October, 2017 08:26:23 AM
i understand all the above, my question is ...this is a medicare pt and we cant use the consult codes, we did not admit the pt, is it proper to still use the 99221?
SuperCoder Answered Fri 06th of October, 2017 05:58:46 AM


When patient is not admitted, CPT 99221 cannot be used for the mentioned service. CPT 99221 code is to report the first hospital inpatient encounter with the patient by the admitting physician. Only the admitting physician reports the initial inpatient care. When a physician from a different specialty than the admitting physician sees the patient, then that physician can report the service separately.

Suggestion: when the provider is visiting the hospital without the admission of the patient, outpatient/office visit (New Patients) or outpatient consultation (New or Established Patients) can be billed.

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