Cardiology Coding Alert

Reader Questions :

ED Visit Often Doesn't Equal ED Code

Question: Sometimes when the cardiologists see a patient in the emergency department, they dictate a consult or an H&P but select 99283. The emergency doctor also sees the patient. Which codes should I report in these situations?

New Hampshire Subscriber

Answer: You should report the appropriate consult and outpatient visit codes for the situation you describe.

An ED visit code (such as 99283, Emergency department visit for the evaluation and management of a patient ...) would not be correct because "for any single ED patient visit, only one physician can report an ED E/M code," according to AMA's CPT Assistant (July 2002).

CPT guidelines for office or other evaluation services state that "a patient is considered an outpatient until inpatient admission to a health care facility occurs."

Result: If the physician's documentation meets the coding requirements of a consult, you should choose from outpatient consult codes 99241-99245, the same CPT Assistant article states. For the H&P (history and physical), determine which outpatient visit codes the documentation supports. Remember that new patient codes 99201-99205 require a history, exam (physical), and medical decision making.

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