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Wiki Consult - ER doctor

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cpccoder2008

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A patient come in through ER, the ER doctor consults surgery and orthopedic. The orthopedic doctor gets there first and decides to admit the patient. The surgery doctor see's the patient on the floor after the ortho doctor decides to admit. My question is since the surgery doctor performed a consult on the inpatient floor but the ER doctor was the reffering can you bill this as an Inpatient Consult with the ER as reffering or should it be coded as an Outpatient Consult with place of service ER and ER as reffering ?? Thanks
 
I would code the Surgeon visit as a Inpatient consult (using consult codes if non-MCare and 99221-99223 if MCare). If you code an outpatient service, your claim will be denied because the hospital claims will show pt's status as Inpt.

This raises a question thou: ER Docs ask for a consult to assist them in treating the patient under their care in the ER. But the Ortho Doc has already taken over this patient and admitted. The person asking for the consult does so because he expects to continue to treat the pt but the ER is no longer treating.

To me the Surgeon missed his window for the ER consult and should get a new consult request from Ortho Doc who admitted. Pt is under the Ortho's treatment plan and could be completely different that what was being done in the ER. Maybe a surgeon consult is not even needed at this time
 
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