4 Points For Easy Inpatient Billing

One of the most difficult medical billing feats is inpatient consultation coding. There are many instances when a follow-up inpatient consult should be replaced by a subsequent hospital care visit. To eliminate these medical billing errors, there are four facts to consider when coding for inpatient consults.

Number one is very obvious. If your report an inpatient consultation exam, the patient must be inpatient, not outpatient. Very often physicians see patients on a consultation basis when they are outpatient. Medical billing mistakes can be made easily. Double check your work.

Number two, it is important in medical billing to always report one initial consultation. This code will correspond with the very first meeting between the physician and the patient. The medical billing codes to use are 99251-99255. If the patient is discharged and then re-admitted, remember that another initial inpatient consultation code may be reported.

Third, you need to make sure subsequent same stay consults are allowed. There are two rules that deem additional consults necessary. First, the doctor sees the patient again because he/she was not able to finish the consult the first time. Second, if the attending physician requests a second consult due to changes in medical condition. The medical billing codes to use for subsequent inpatient consults are 99261-99263.

Fourth and final point, Get your consult coding right. If your physician assumes responsibility for a patient’s care after the initial consult, you should not report additional consult codes for that stay. Instead, the correct medical billing policy is to bill subsequent hospital care codes 99231-99233.

Following these four rules will make your inpatient consultation coding a snap. Be sure to adequately train your medical billing staff about inpatient consultation and claims will be submitted with more accuracy.

View all Articles by: Kathryn E, CCS-P - Retired