CPT Knowledgebase - Jun 2, 2023
Please help clarify how to interpret this portion of the guidelines. “If a consultation is performed in anticipation of, or related to, an admission by another physician or other qualified health care professional, and then the same consultant performs an encounter once the patient is admitted by the other physician or other qualified health care professional, report the consultant’s inpatient encounter with the appropriate subsequent care code (99231, 99232, 99233). This instruction applies whether the consultation occurred on the date of the admission or a date previous to the admission. It also applies for consultations reported with any appropriate code (eg, office or other outpatient visit or office or other outpatient consultation).” Does this mean if a consultant has seen the patient previously for the same problem they are admitted for, the consultant must report subsequent visit codes? We understand if a consult results in admission or recommendation for admission and they see them in the hospital that subsequent visits would make sense. But if the patient has not been seen in a year (or longer), why would an initial service/ consult code not be used?”To view the Official AMA answer and 1000s more like this:
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