The Admission Consult

Code These Cases

Case 1: A surgeon admits a patient for a fractured hip. This 75-year-old white female has a longstanding history of hypertension and chronic obstructive pulmonary disease (COPD). Upon admission, the patient’s blood pressure is significantly elevated with (self-reported) elevated readings over the past week. The surgeon requests a consult for assessment and treatment of uncontrolled hypertension. What service(s) can the hospitalist report?

The Solution

The surgeon requested the hospitalist’s opinion regarding uncontrolled hypertension. The request is documented in the medical record, the hospitalist performs the evaluation and documents his recommendations. Given the nature of the patient’s condition, the hospitalist initiates treatment and remains on the case. The hospitalist reports the appropriate level of consultation (99251-99255) with the codes ICD-9-CM 401.9 (essential hypertension, unspecified) and 496 (COPD, not otherwise specified).

Case 2: The patient in the first case is medically stabilized and the surgeon proceeds with surgery. Postoperatively, the patient’s COPD begins to flare as her respiratory status is compromised by the anesthesia. The surgeon requests the hospitalist’s advice on the postoperative management of the patient’s COPD. What service(s) can the hospitalist report?

The Solution

Because the hospitalist provided preoperative care to the patient, only subsequent hospital care codes 99231-99233 with 496 (COPD, not otherwise specified) and 401.9 (essential hypertension, unspecified) for the postoperative involvement may be reported, even though the consult is requested for different problem.