Medical Auditing Practice Exam

According to CPT® coding guidelines, how many consultations can a consultant report per hospital admission?

1. Multiple consultations

2. None

3. Only one consultation

4. As determined by the hospital

The correct answer is: Only one consultation

In the context of CPT® coding guidelines, a consultant can report only one consultation per hospital admission. This rule ensures clarity and consistency in billing practices and highlights the importance of the initial consultative service provided to a patient during their hospital stay. The rationale for limiting to a single consultation is to avoid overlapping services that could lead to confusion regarding the care provided. A consultant is expected to assess the patient's condition comprehensively during that first encounter and provide recommendations based on their expertise. Any subsequent evaluations or interactions that arise in a different capacity, such as follow-up visits, would typically not qualify as a new consultation for coding purposes. In contrast, the other options suggest scenarios that do not align with the established guidelines. Allowing multiple consultations could complicate the medical record and billing process, while claiming none would disregard the recognized role of the consultant altogether. The notion that the number of consultations could be determined by the hospital does not align with standardized coding practices established by coding authorities. Thus, the regulation to report only one consultation aligns with the structured approach of CPT® guidelines and promotes proper documentation in the reimbursement cycle.