Outpatient Facility Coding Alert - 2005 Issue 11
CPT Consolidates Consult Coding for 2006
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Article Overview
This article reviews CPT 2006 changes that reshape consultation reporting for physicians, with emphasis on inpatient follow-up services, confirmatory/second-opinion visits, and related E/M options. It is aimed at coders, auditors, and physician office staff who need to understand how the updated CPT structure affects documentation and claim selection for hospital, outpatient, and facility settings.
Why This Topic Matters
The update changes how common consult scenarios are classified and reported, which affects documentation, code selection, and potential payer coverage questions for physicians and facilities.
Article Sections
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All Follow-ups Become Subsequent Care
Discusses the shift in how later visits during the same inpatient stay are categorized under CPT 2006. It also frames the change in relation to hospital and nursing facility E/M reporting.
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Don't Overlook Initial Consult
Covers the first-visit consultation context and how it differs from later inpatient encounters. This section includes an example involving associated testing and same-day service considerations.
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Celebrate the Change
Summarizes the practical impact of the coding revision for documentation and coder workflow. It also notes relative reimbursement considerations in broad terms.
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Forget About 99271-99275
Addresses the removal of confirmatory consultation reporting and the shift toward other E/M categories for second-opinion scenarios. A patient example illustrates the broader setting in which these services arise.
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Ask for an ABN for Second Opinions
Discusses beneficiary notice considerations and potential coverage concerns when a patient seeks a second opinion or confirmation. It also notes why payers may scrutinize these services.
What You Will Learn
- How CPT 2006 changes consultation reporting for inpatient follow-up visits
- How initial consultation scenarios differ from subsequent care reporting
- How second-opinion and confirmatory consultation scenarios are treated under the updated framework
- What documentation and beneficiary-notice issues may arise with these services
- Which broad E/M categories remain relevant after the consultation code changes
Who Should Read This
- Medical coders
- Coding auditors
- Physician office staff
- Hospital billing staff
- Physicians
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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