tci Medicare Compliance & Reimbursement - 2013 Issue 2

Reader Question: Check Individual Payer Consultation Rules

Question: If my doctor sees a patient in the office for something like diabetes, then the patient is admitted for something else and the admitting physician consults my doctor about the diabetes, is it a new consult? Answer: In this case the coding would depend on the payer’s consultation rules. If following Medicare rules, in-hospital consultations are billed with the initial hospital visit code 99221-99223 (Initial hospital care, per day, for the evaluation and management of a patient …) whether the patient is old or new. The same holds true if the payer follows CPT® rules. In-hospital...

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