Wiki ER Consult Coding Clarification


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Hello Everyone!
I hoping I can find some help in a situation that has come up with correct coding.
So the scenario is as follows:

ER doctor (Dr. A) calls in my physician (Dr. B) for a consult. Dr. B sees the patient in the ER and after this consult Dr. A decides to admit the patient. Dr. B is NOT the admitting physician, but he does however do follow up care each day once the patient is admitted into the hospital. Which code is the proper E/M to use as the consulting, but not the admitting physician.

We are also looking at what is allowed by Medicare in this situation as well.

Thanks for your help!!!
Consult or ED visit?

If MD is consulted and pt is D/C then use ED visit codes 99821-99285 POS 23.

Commercial payers or Medicare: for this visit it can not be a consult, your provider chose to follow pt in their treatment.

If the patient is going to be admitted by another MD, you will have to find out if pt is going to be admitted under observation status or as an inpatient.

If the patient is admitted for observation, you would use either the new office patient codes 99201-99205 or the established office patient codes 99211-99215 (depending on whether or not the patient has been seen by your MD or group in the past three years).

If the patient is being admitted as an inpatient, you would perform and document your "consult" (which you visit is not a consult) as an H&P (99221, 99222, 99223) without attaching the AI modifier (AI modifier is only for the admitting provider, of course if your MD is the admitting provider then you do use AI).

If you had a true consult out patient commercial payer only, you would then need the complete 3 R's documented = 1 request, who requested you and for what 2 rendering your opinion for treatment 3 reply to you requester, and use consult codes 99241-99245

If you had a true consult Medicare, you would then need the complete 3 R's documented (as above), and use consult codes 99201-99205 new pt OR 99211-99215 established pt which ever applies.

hope this helps some, I know it is confusing.