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taurus7694

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PLEASE HELP..
3/5/09 pt seen in ER following Motor Vehicle Accident...found to have fx ankle and fx wrist....ER doc calls Ortho Dr who wants the pt to be splinted for ea fx...pt was admitted for neurovascular checks and pain control

3/6/09..next day...Ortho Dr visits patient ..does exam...decides to have pt ice, rest and elevate..splint to allow for swelling..PT, gait training
Discussed conservative vs operative management for the fractures....pt decides she would like to proceed with surgical intervention and this will be scheduled at later date...after swelling subsides.

Question: Since our Ortho Dr didn't see pt while in ER...they saw her the next morning after she was admitted....is this 99222 for our Ortho Dr or is there something we are missing when coding for inpatient visit??
 
taurus7694 said:
PLEASE HELP..
3/5/09 pt seen in ER following Motor Vehicle Accident...found to have fx ankle and fx wrist....ER doc calls Ortho Dr who wants the pt to be splinted for ea fx...pt was admitted for neurovascular checks and pain control

3/6/09..next day...Ortho Dr visits patient ..does exam...decides to have pt ice, rest and elevate..splint to allow for swelling..PT, gait training
Discussed conservative vs operative management for the fractures....pt decides she would like to proceed with surgical intervention and this will be scheduled at later date...after swelling subsides.

Question: Since our Ortho Dr didn't see pt while in ER...they saw her the next morning after she was admitted....is this 99222 for our Ortho Dr or is there something we are missing when coding for inpatient visit??
Click to expand...

For the 3/6 hosp visit-Ortho doc can bill for a consult w/ modifier 57 (decision for surgery)

Hope this helps.
 
Who is admitting physician?

It is NOT a consult ... the ER physician is not asking for advice or opinion on how to treat. The ER physician has transfered the care to the Ortho surgeon.

If the patient was admitted as an inpatient in the Ortho doc's name then his first visit with the patient is an initial hospital visit 99221-23 (depending on documentation).

If the patient was admitted to observation in the Ortho doc's name, then the first visit with the patient is initial observation care 99218-20 depending on documentation.

If the patient was discharged on the same date as the doctor first saw her, then code 99234-36 as per documentation.

If the patient was admitted to another physician's service, then the Ortho doc codes a 99231-33 depending on documentation, UNLESS there is a clear request for a consultation from the admitting service (probably not since they just want Ortho to take care of the fractures - i.e. transfer of care).

You need the -57 modifier ONLY if surgery will be within a couple of days or during this same hospital admit.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
in the Medicare Claims Processing Manual, section 30.6.11 F.

http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf

If 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. 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.

Mary, CPC, COSC
 
Consult vs visit

Mary,
I absolutely concur.

But my reading of the original posting is that the Ortho surgeon did not see the patient at all until the next day ... i.e. had a phone conversation w/ ER doc about splinting and admitting, but didn't actually see and examine the patient until the next day.

I based my response on my understanding of the scenario.

F Tessa Bartels, CPC, CEMC
 
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