The Admission Consult

The Hospitalist. 2007 December;2007(12):

December 1, 2007 | The Hospitalist

Alternately, the surgeon may continue on the case, not transferring the care for the remaining portion of the hospitalization to the hospitalist, and incorporating the hospitalist’s recommendations into his/her own care plan, subsequently retaining the hospitalist’s services in assisting with care. Because the transfer did not occur prior to the consultation, this situation may constitute an inpatient consultation and be reported as such.

Unfortunately, some local Medicare contractors do not recognize this latter distinction and prohibit reporting post-surgical involvement with 99251-99255. TH

Carol Pohlig is a billing and coding expert with the University of Pennsylvania Medical Center, Philadelphia. She is also on the faculty of SHM’s inpatient coding course.

Code These Cases

Case 1: A surgeon admits a patient for a fractured hip. This 75-year-old white female has a longstanding history of hypertension and chronic obstructive pulmonary disease (COPD). Upon admission, the patient’s blood pressure is significantly elevated with (self-reported) elevated readings over the past week. The surgeon requests a consult for assessment and treatment of uncontrolled hypertension. What service(s) can the hospitalist report?

The Solution

The surgeon requested the hospitalist’s opinion regarding uncontrolled hypertension. The request is documented in the medical record, the hospitalist performs the evaluation and documents his recommendations. Given the nature of the patient’s condition, the hospitalist initiates treatment and remains on the case. The hospitalist reports the appropriate level of consultation (99251-99255) with the codes ICD-9-CM 401.9 (essential hypertension, unspecified) and 496 (COPD, not otherwise specified).

Case 2: The patient in the first case is medically stabilized and the surgeon proceeds with surgery. Postoperatively, the patient’s COPD begins to flare as her respiratory status is compromised by the anesthesia. The surgeon requests the hospitalist’s advice on the postoperative management of the patient’s COPD. What service(s) can the hospitalist report?

The Solution

Because the hospitalist provided preoperative care to the patient, only subsequent hospital care codes 99231-99233 with 496 (COPD, not otherwise specified) and 401.9 (essential hypertension, unspecified) for the postoperative involvement may be reported, even though the consult is requested for different problem.