Subspecialty Corner

Abstract

In January 2006, Current Procedural Terminology (CPT®) deleted the codes for inpatient follow-up consultations (99261–99263) and confirmatory consultations (99271– 99275). Knowing how to report these services requires a good understanding of the general guidelines for reporting consultations.The office or outpatient (99241–99245) and initial inpatient hospital (99251–99255) consultation codes require all 3 key components (history, physical examination, medical decision making) to be performed and documented. Time may be used as the key or controlling factor in the selection of the code if more than 50% of the total face-to-face time (in the inpatient setting, face-to-face time includes floor or unit time dedicated to the one patient) is spent in counseling or coordination of care. When reporting the service based on time, medical record documentation must include the total face-to-face time, the time spent in counseling or coordination of care, and a summary of the issues discussed. The Table defines the requirements for each code.Do not be concerned about losing the codes for confirmatory and follow-up inpatient consultations. These codes were deleted from CPT because they were thought to be unnecessary—other evaluation and management service codes capture the services very well. Loss of revenue is also not a factor because the deleted codes generally were assigned a Medicare relative value unit that was and is lower than an equivalent subsequent care service, initial consultation, or new patient office or outpatient visit that would be reported under the new guidelines.Use care to select the appropriate code for an initial or confirmatory consultation based on the performance and documentation of the CPT requirements (3 Rs), the level of service performed and documented, and the place of service. Report follow-up inpatient and nursing facility consultations with the subsequent care codes based on the level of service provided and documented and the place of service in which the consultation was performed.