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Bill consult or no charge?

Cheri CPC

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Local Chapter Officer
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The physician did a debridement to bone (10 days global) in the office and then sent the patient to emergency dept, patient admitted. While inpatient at hospital the physician was called to consult the patient for the same wound, twice, which he did. My question is can the consultations be billed? Both were in the global period. Or would this be 99024 follow up in global as it was for the same problem?

Thanks for any advice!
 
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Global

I usually fight for every consult, but I think these visits would be global ... it's the same problem for which the procedure was performed.

F Tessa Bartels, CPC, CPC-E/M
 

ARCPC9491

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To me, even though the dr was called for 'consult' - I wouldn't consider it 'truly' a consult. Your doctor was managing the wound from the start and he was called in, probably for that reason <given that he saw the patient twice> This is much rather a referral, since your doc was assuming the care of the problem he was already managing. Which means that if inpatient, your docs services would be categorized as subsequent care. But even so, consult or subsequent care, I agree that it would be more than likely denied for global. Now if your patient's wound got infected or something that required the admission, that's a little different, and you have more of a fight to get it paid. Don't forget you'd probably also have to use modifier 24.

Now, if this truly was a 'referral' <for the reasons mentioned above> and subsequent care codes would be used, I would code out 99024, post op visit.

However, I agree with Tessa, I always fight for consults... if the documentation supports a consult all the way... I'd at least try to get it pushed through and paid, it's always worth a shot, but don't hold high hopes!!

Oh, I noticed can "both consults" be billed - No, only one E/M per day. You'd have to combine the visits together and bill only one code... That is, if you decide it's billable. :)
 
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Cheri CPC

Contributor
Local Chapter Officer
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Thanks so much for your help! I'm going to go with the 99024, he was called for wound care, which he did, (only one wound, which is in global), I just don't want to be missing something, going to the hospital twice, after hours, writing orders, dictating full reports, is a lot of extra work!

Thanks again! I really appreciate it!

Cheri
 
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