FEB 02, 2016
Inpatient consultation billing
Question: Our physician saw a Medicaid patient in the hospital and submitted CPT consultation code 99254, which was processed appropriately. While still inpatient, our physician saw the patient a second time for a corneal ulcer and submitted CPT consultation code 99251. This time our claim is disallowed because we billed a new-patient consult for an established patient. What code should we use?
Answer: For inpatient consultations, CPT states “Only one consultation should be reported by a consultant per admission.” Use subsequent hospital care codes 99231-99233.