Wiki CONSULT IN THE ER

[kwrenn]

Hello. Anesthesia coder here... new to E/M coding. We recently started billing for a Plastic surgeon who sometimes performs consultations in the ER. What E/M would be most appropriate for a consult in an ER? I understand he has to meet the 3 R's for the consult, but I'm unsure of which E/M is most appropriate? As an example, a patient with a gunshot wound to the face he exams in the ER, he believes he can bill an inpatient consult code (99251-99255). However, I disagree since the patient hasn't been admitted yet. These patients are usually admitted shortly thereafter. Is it more appropriate to bill an ER E/M (99281-99285)? I understand Medicare and some commercial payors don't accept consult codes, which makes it all that more confusing. Any advice or guidance is most appreciated. Thank you.

 

[SharonCollachi]

As an example, a patient with a gunshot wound to the face he exams in the ER, he believes he can bill an inpatient consult code (99251-99255). However, I disagree since the patient hasn't been admitted yet.

You are correct.

 

[kwrenn]

Thank you.

 

[dkissel]

You may also use outpatient (office) codes as appropriate in the ER. 99201-99205 for a new patient for 2020.