Seeing patients who present with chest pains in the emergency department is par for the cardiologists course.
But from which category of Evaluation and Management (E/M) services codes do you select: office or other outpatient, emergency department, hospital inpatient, consultations or critical care?
Without an adequate understanding of a cardiologists role in the ED and how to code for it, you could be shortchanging your practices revenue, not to mention asking for an audit, say national experts in E/M coding.
Here are five tips to help you pick the right E/M code for your cardiologists in the emergency department:
1. Know the difference between a consult and transfer of care.
Improperly billed consultations are high on the HCFA fraud and abuse list, cautions Thomas Kent, CMM, seminar leader for McVey and Associates, and president of Kent Medical Management in Nevada, CA.
Auditors, who are checking to see if services should have been downcoded from a consult to an outpatient visit, have been winning a lot of money, he says. However, you dont want to automatically downcode, because your practice is ethically entitled to bill for true consults. First, check the documentation and talk with the cardiologist. For example, look and listen for the following key components of a consultation as stated in the CPT manual:
The request for consultation from the attending ED physician must be documented in the patients record.
In the course of rendering that opinion, a consulting specialist may initiate therapeutic treatment, order diagnostic tests and perform services. The results must then be communicated back to the requesting ED physician in a written or verbal report. (Although the CPT Codes does not specify which form the communication must take, it should be documented in the patients record by both the cardiologist and the ED physician.)
Also, remember that HCFA has a different definition of the term consultation than CPT. HCFA does not have to go by the CPT Guidelines, and they are the ones doing the auditing, warns Steve Arter, executive vice president in the compliance and education division, QuadraMed Corporation, Point Richmond, CA.
Section 15506 of Medicare clearly states that a consultation is advice only, he says. To be on the safe side, make sure there is documentation between the ED physician and the cardiologist showing the initial request for consulting as well as the additional request to treat. Such a paper trail, notes Arter, could keep you out of trouble if HCFA auditors try to interpret the initiation of treatment as transfer of care.
