99284 billed by a specialist?

CynthiaT

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My physician is billing a 99284 however, he is not the admitting nor attending physician. The patient was admitted to inpatient status, as well. Can my physician bill the 99284 or, is another CPT more appropriate? I know this is a pretty general question but, I will provide more information if necessary.

Thanks in advance!
 

RebeccaWoodward*

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Possibly...depending on your circumstance.

Emergency Department Physician Requests Another Physician to See the Patient in Emergency Department or Office/Outpatient Setting

If the emergency department physician requests that another physician evaluate a given patient, the other physician should bill a consultation if the criteria for consultation are met (Was this a consult request?). If the criteria for a consultation are not met and the patient is discharged from the Emergency Department or admitted to the hospital by another physician, the physician contacted by the Emergency Department physician should bill an emergency department visit. If the consulted physician admits the patient to the hospital and the criteria for a consultation are not met, he/she should bill an initial hospital care code.
http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf

30.6.11
 

CynthiaT

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I want to see if I am understanding this... So, if the Emergency Dept. physician (Doctor A) asked my doctor (Doctor B)to see the patient and, then another physician (Doctor C) comes along and admits the patient. Then, my doctor (Doctor B) would bill an emergency dept. visit (99284)? Is this only if the requirements for a consultation were not met?


Thanks, again!
 

RebeccaWoodward*

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I want to see if I am understanding this... So, if the Emergency Dept. physician (Doctor A) asked my doctor (Doctor B)to see the patient and, then another physician (Doctor C) comes along and admits the patient. Then, my doctor (Doctor B) would bill an emergency dept. visit (99284)? Is this only if the requirements for a consultation were not met?


Thanks, again!
You got it! ;)

Now...just an FYI---some commerical carriers may frown on the ER code if they see a specialist billing for it. They may want to see an outpatient code...99201-99215. 99284 carries more RVU's than 99204 (example) so it may worth appealing with CMS' reg.
 
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