Wiki Consult code in ER

[jdibble]

I have gotten denials on consult codes in the from two separate insurance companies and I'm not sure why!

My hospitalists were consulted in the ER for two different patients - children -and the insurance companies, Amerigroup and Healthnet denied the claims submitted with the Consult codes. Amerigroup stated they denied the claim for POS and CPT code not matching. When the billing dept. called they were told that we had no grounds for appeal because the ER EM codes are 99281-99288 and we billed with an "office" consult code. CPT states that 99424 is office or OTHER outpatient consult and specifically states to use in ER. Can someone offer an idea why this would deny - should I be billing with another code? Any suggestions on how to get these visits paid?

Thanks for all your help.

Jodi Dibble, CPC

 

[gagnonangela]

Both Healthnet and AGP are gov't payors, as of Jan 1, 2010, Medicare is no longer paying or accepting consult codes. This may be the problem.

 

[theresa.dix@tennova.com]

denials for consult in ER setting

For Medicare payors you need to use ER vst codes for Consults done in the ER.
They are

99281-99285