Primary Care Coding Alert

Question: An emergency department physician requested that a family physician come to the hospital to treat a child who is under the FP's care. May I report the encounter as a consultation?


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Answer: The answer depends on whether the visit meets a consultation's criteria. If the ED physician made a formal request and the FP sent a report back to the ED doctor, you should use a consultation code (99241-99245, Office consultation for a new or established patient ...). This means the ED physician asked the FP's opinion and the FP did not completely assume patient care.

But because your case involves a child, the ED physician may have wanted the patient's primary-care physician, who is familiar with children, to examine the patient. In this case, you should use an ED code (99281-99285, Emergency department visit for the evaluation and management of a patient ...).

Watch out: If the ED physician admits the patient to the hospital and the FP later assumes inpatient care with total management, you should instead use subsequent hospital care codes (99231-99233, Subsequent hospital care, per day, for the evaluation and management of a patient ...). Reporting 99231-99233 will avoid duplicating the ED's billing of initial hospital care (99221-99223, Initial hospital care, per day, for the evaluation and management of a patient).

Answers to You Be the Coder and Reader Questions provided by Barbara J. Cobuzzi, MBA, CPC, CPC-H, CHBME, president of CRN Healthcare Solutions in Shrewsbury, N.J.; Daniel S. Fick, MD, director of risk management and compliance for the College of Medicine faculty practice at the University of Iowa in Iowa City; Kent J. Moore, manager of Health Care Financing and Delivery Systems for the American Academy of Family Physicians in Leawood, Kan; Dennis Padget, president of Padget and Associates in Simpsonville, Ky.; and Gretchen Segado, MS, CPC, director of reimbursement compliance at New York University School of Medicine.