Health Information Management

Q&A: Inpatient consultation codes

HIM-HIPAA Insider, August 3, 2010

Want to receive articles like this one in your inbox? Subscribe to HIM-HIPAA Insider!

Q: Will you provide more information about inpatient consultation codes? Please explain how to separate these codes from inpatient admission codes.

A: With the exception of telehealth consultation services (which are reported with G codes), Medicare no longer recognizes inpatient consultation codes beginning in fiscal year 2010. However, most insurance companies (other than Medigap and Medicare Advantage plans) still recognize them, so you must determine what insurance company you’re working with and whether it still recognizes these codes. Gradually, more and more insurance companies will most likely jump on board with Medicare’s policy.
In the past, initial hospital care codes (99221–99223) were limited to the admitting physician. That changed with Medicare’s new policy. When a specialist evaluates an inpatient for what would otherwise have been termed a consultation, the specialist must now report the initial hospital care codes.
Reporting an -AI modifier (principal physician of record) identifies the admitting physician—rather than a specialist—as the principal physician of record (i.e., the one who oversees and coordinates the patient’s care during his or her hospital stay). Using the -AI modifier does not result in additional reimbursement, as the modifier is simply informational.
Report all subsequent inpatient visits by the admitting physician or a specialist using the subsequent hospital care codes (99231–99233).
Editor’s note: Peggy S. Blue, MPH, CPC, CCS-P, regulatory specialist at HCPro, Inc., in Marblehead, MA, answered this question in the July issue of Briefings on Coding Compliance Strategies.

Want to receive articles like this one in your inbox? Subscribe to HIM-HIPAA Insider!

Most Popular