tci Medicare Compliance & Reimbursement - 2019 Issue 5

Reader Question: Spot Consultation Conundrums With Office Versus Inpatient Expertise

Question: What is the difference between an office consultation and an inpatient consultation? When should we use each code set? SuperCoder Subscriber Answer: You would use the codes depending on the patient’s hospital status at the time of the consultation. According to CPT® 2019, you should report inpatient consults when “an inpatient consultation is performed on a date that the patient is admitted to a hospital or nursing facility.” You would report inpatient consults with codes from 99251 (Inpatient consultation for a new or established patient, which requires these 3 key components: A problem focused history...

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