Medical Billing Forum

Billing => Billing => Topic started by: Yesica on October 26, 2009, 05:07:59 PM

Title: Inpatient Consult Vs. Subsequent
Post by: Yesica on October 26, 2009, 05:07:59 PM
Hello everybody,

In need help and any help will be greatly appreciated. I have a question regarding hospital billing. We have a patient that was seen by the doctor he is not the admitting physician, he saw the patient for the first time I was told to bill the Inpatient Consult i think this is wrong and i should be billing a subsequent visit. When we bill Inpatient Consult it needs the same qualifications as if we were be billing a Outpatient Consult am I correct?I searched for answer but i dont seem to find anything that specifies my concerns.

Thanks.
Title: Re: Inpatient Consult Vs. Subsequent
Post by: Michele on October 26, 2009, 06:38:38 PM
Based on the info you've given, I'm not sure why you feel you should be billing a subsequent visit.  You stated it was the first time the physician saw the patient.  The cpt code book shows the qualifications needed for the consult, both inpatient and outpatient.  I'm just not sure on what you are basing your reason for not believing the consult would be appropriate.  Maybe a little more info would help.

Michele
Title: Re: Inpatient Consult Vs. Subsequent
Post by: Yesica on October 27, 2009, 01:48:29 PM
A inpatient consult code needs the same requirements as a Outpatient Consult am i correct? This is why i really think i shouldnt be using this when there wasnt a referral.
Title: Re: Inpatient Consult Vs. Subsequent
Post by: Michele on October 27, 2009, 08:28:06 PM
I am not that familiar with the rules for billing consults, but I don't see where it indicates that it has to be a referral.  The requirements are the same.  So I guess my next question is are you the biller, or the coder?  If you are not responsible for coding, and you are being told to bill a consult by the person responsible for the coding, I would go ahead and bill the consult.  Unless you know that the code is truly inappropriate.  If you are the coder, then I would pull out the patient chart, and the cpt book and see if it meets the criteria.

Michele
Title: Re: Inpatient Consult Vs. Subsequent
Post by: Yesica on October 29, 2009, 10:21:38 AM
I mean the patient has to be referred to the doctor not a referral. I do the billing but when i see errors i will tell the coder.
Title: Re: Inpatient Consult Vs. Subsequent
Post by: sherry27 on November 02, 2009, 02:34:58 PM
i do billing and coding for hospitalist. The coder is correct. There is only one set of inpatient consult codes. The doctor can bill a consult or a subsequent visit if he is not the admitting physician. Most always if the dr is not the admitting dr, he will bill the consult code the first day because the admitting dr said "Hey, check on my pt" (so to speak).    For inpt consults you don't have to have the big report from the pcp requesting a consult, the rules are easier. (I hope this makes sense to you ;)