Wiki ED Coding Question

[codeseeker]

This pertains to a surgeon who is a consulting physician (i.e., not the admitting physician), who is asked to see a patient in the ED, who is then admitted by the hospital ED doctor. The surgeon then sees the patient as an inpatient on two subsequent days. Here is the scenario:
Surgeon sees patient on 4/1/21 in the ED who gets admitted to inpatient care on the same day, and then the same surgeon sees the same patient on 4/2 and 4/3 as an inpatient.

Which of the 2 following strategies would you use to code the visits:

1. Strategy #1: Code the 4/1 visit with an ED code (99281-99285; using POS 23), then code the 4/2 visit as an inpatient consultation (99251-99255; using POS 21) and the 4/3 visit as subsequent inpatient visit (99231-99233; using POS 21), or
2. Strategy # 2: Code 4/1 with an inpatient consultation code or an initial hospital care code (99221-99223) (using POS 21) , then code 4/2 and 4/3 a subsequent inpatient visits (using POS 21).

If, on the other hand, the surgeon is the admitting physician, would you use strategy # 2? Also, how would you decide between using the initial hospital care codes vs. inpatient consultation codes for the initial inpatient visit?

Thank you very much.

 

[thomas7331]

1 and 2 are both incorrect for your scenario. If the consultation was done in the ED prior to admission, you would bill the ED code as you've indicated, but you would not bill another consultation after admission. If the surgeon continues to follow the patient after admission, then you would bill the inpatient care codes as appropriate per the documentation (99221-3 for the initial, if supported, and 99231-3 for subsequent visits). If the consultation was done after the admission order was written (whether done in the ED or on the floor), then you could use codes 99251-92555 for that initial service if the payer accepts consultation codes, or otherwise use the coding you've described in #2.

If the surgeon is the admitting physician, then you situation is quite a bit different. As the admitting physician, they are assuming care of the patient and not acting as a consultant. They would bill the initial inpatient code for the admission and subsequent care thereafter but keep in mind that if there is a surgery involved, then you would not bill for any visits that fall into the global period with the exception of the initial evaluation involving the decision for a major surgery the day of or the day prior to the procedure. If the decision to perform the procedure had been made prior to the admission, then there would be no inpatient hospital codes billed unless the E/M service was unrelated to the procedure and supported a modifier 24.

 

[codeseeker]

Thomas- thank you very much for your excellent elucidation. One follow-up question: If the consultation was done in the ED prior to admission and an ED code was used, why can we no longer use a inpatient consultation code for subsequent visits? Thank you again.

 

[thomas7331]

Thomas- thank you very much for your excellent elucidation. One follow-up question: If the consultation was done in the ED prior to admission and an ED code was used, why can we no longer use a inpatient consultation code for subsequent visits? Thank you again.

Billing a consultation requires that a consultation has been requested by another provider, and per the guidance in CPT: "If subsequent to the completion of a consultation the consultant assumes responsibility for management of a portion or all of the patient's condition(s), the appropriate Evaluation and Management services code for the site of service should be reported." So you would not report a consultation code for a subsequent visit (unless in the unusual circumstance that a second consultation has been ordered by another provider, e.g. for a new problem or change in the patient's condition). If your provider is just continuing to follow the patient for the same issue, it's no longer a consultation after the initial evaluation.

 

[codeseeker]

Thanks so much. Your help is so much appreciated. Going back to my first question - if the surgeon does a procedure with a 0 global day period, and then comes back to see the inpatient on subsequent days, I assume that a consultation code would not be allowed for the follow-up visits for the same reason you just mentioned. So all follow up visits would be reported with the standard subsequent inpatient care codes . Am I correct on that assumption?

 

[thomas7331]

Thanks so much. Your help is so much appreciated. Going back to my first question - if the surgeon does a procedure with a 0 global day period, and then comes back to see the inpatient on subsequent days, I assume that a consultation code would not be allowed for the follow-up visits for the same reason you just mentioned. So all follow up visits would be reported with the standard subsequent inpatient care codes . Am I correct on that assumption?

Yes, you can only bill a consultation when a consultation is performed - it has to be requested by another doctor, and then performed with a written report back to the requesting provider (the '3 R's'). See the guidelines in the CPT under this section for more information. Follow-up visits are not consultations.

 

[maebelle@gmail.com]

You would bill the appropriate ED code, but for the subsequent visits in the hospital, you would bill subsequent inpatient hospital codes (99231-99233) for both subsequent visits. Codes 99221-99223 are to be used by the admitting physician only.