Practice Management Alert

Question: One of my surgeons consulted on a Medicaid patient in the emergency room (ER) for an incarcerated umbilical hernia. The surgeon suggested using 99283 because the patient never left the ER, but the latest Medicare guidelines prevent this. What's the proper E/M code for this service? Maine Subscriber Answer: Each state Medicaid carrier sets their rules. So you first have to find out if your state's Medicaid is following Medicare's rules, which are ignoring consultation codes as of January 1, 2010. Depending on the rules for your state Medicaid, you might use 99283 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of moderate complexity ...) if the Medicaid payer does not recognize consultation codes. Code 99283 is not limited to just the physician employed by the [...]