Wiki 99281 vs Outpatient services

[joylyn]

We are a specialist office and when we do a consult in the ER, we have been using an outpatient code. IDPA is now denying saying use 99281. We have always been under the impression that was for use with ER docs. Any experience with this. Thanks

 

[Mayzoo]

CPT guidelines state 99281-99285 are:

"used to report evaluation and management services provided in the emergency department."

It does not state that the service is by an ED doctor, just that the service is provided in the ED.

A more seasoned coder hopefully will chime in.

 

[twizzle]

ER consults

We are a specialist office and when we do a consult in the ER, we have been using an outpatient code. IDPA is now denying saying use 99281. We have always been under the impression that was for use with ER docs. Any experience with this. Thanks

Basically, if a provider is called to do a consult in the ER they bill the ER codes but only if the patient is seen in the ER and then goes home. If there is an order for an admit then they would bill a consult/visit instead.

 

[cfeilner]

Basically, if a provider is called to do a consult in the ER they bill the ER codes but only if the patient is seen in the ER and then goes home. If there is an order for an admit then they would bill a consult/visit instead.

For Medicare only patient's that come into the ED but leave after triage, can the facility charge the 99211 instead of the 99281?
Thank you in advance for any insight!