Urology Coding Alert

Question: An ER doc refers a patient to our office for a kidney stone. Can we charge for a consultation? Is there any difference in that the referring physician is an ER doc versus any other specialized doctor? Nevada Subscriber Answer: A patient referred to you from the emergency room (ER) is never a consultation. You should bill these patient visits using the new patient E/M codes (99201- 99205, Office or other outpatient visit for the evaluation and management of a new patient ...). If your urologist has seen the patient in the past three years, instead report an established patient E/M code (99211-99215, Office or other outpatient visit for the evaluation and management of an established patient ...). Why: When an ER physician refers a patient to your office for treatment of a condition, such as a kidney stone,  your urologist will not return the patient to the ER [...]