Coding Corner Answer

Answer: D & E

In this scenario, the neonatologist is consulted by the pediatrician and not admitting the baby under their service and therefore A and B would be incorrect. The note must include the name of the referring physician and the reason for the consultation. Consultation codes may be time-based or based on the level of medical decision making. The consulting neonatologist determines the nature and extent of the history and physical examination. The extent of history and physical examination is not an element in selection of the level of the consultation code. Moderate decision includes one of the following: one or more chronic illness with mild exacerbation, two or more chronic illnesses, undiagnosed new problem with uncertain prognosis. For this baby congenital syphilis is a new diagnosis with uncertainty until the labs are resulted. 2023 AMA CPT E&M Changes guideline is that only a medically appropriate history and exam (which is move away from the prior request for comprehensive history and exam) is needed.

99253 may be used when 45 Minutes are met or exceeded or low decision making. Low decision making includes one of the following: 2 or more self-limited or minor problems, 1 stable chronic illness, 1 acute, uncomplicated illness or injury, 1 stable acute illness, or 1 acute, uncomplicated illness or injury requiring hospital inpatient or observation level of care.

CMS and many private insurers do not accept the consult codes so they must be cross-walked to receive payment (usually done by the billing office).

E is also the correct answer as a lumbar puncture is not bundled with the consultation code. 62270 should be used as the spinal tap was done for diagnostic purposes and without imaging guidance.

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