A patient is admitted to cardiology service as an inpatient. The admitting cardiologist sees the patient and completes a history and physical on day one of the inpatient admission. Based on the cardiologist’s initial evaluation, it is determined that the patient requires a pulmonology consult for evaluation of wheezing. The pulmonologist sees the patient on day two of hospitalization. The consultation is complex in nature and meets the high level of medical decision making (MDM) criteria. Does the pulmonologist report CPT code 99223 (Inpatient hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and a high level of medical decision making) or 99233 (Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and a high level of medical decision making) with modifier 26 (Professional Component) appended to it? ...
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Article Overview
This article addresses a hospital inpatient scenario involving a cardiology admission and a pulmonology consult on a later day. It explains, at a high level, how the relevant Evaluation & Management guidance applies to consulting physicians and why modifier use is discussed in this context. The piece is aimed at coders, billers, and clinicians who need to understand how inpatient physician visits are categorized when one specialist is asked to evaluate a hospitalized patient.
Why This Topic Matters
Correctly identifying the type of inpatient physician service affects claim reporting and helps avoid using an inappropriate modifier in a situation involving separate physician services.
What You Will Learn
- How inpatient physician services are categorized when one physician requests another specialist’s input
- How the timing of the consult relates to initial versus subsequent hospital care
- How modifier discussion fits into a hospital inpatient physician service scenario
- How Evaluation & Management guidance is applied in a consultant setting
Who Should Read This
- Medical coders
- Billing staff
- Physicians
- Compliance staff
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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