ER Consult - Often times our Interal Medicine Physicians

lljenkins

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Often times our Interal Medicine Physicians are called to the ER by the ER doc
for a patient they think needs admitted. Once our doctors sees the patient he decides otherwise and sends the pt home. Our doc's want to code this as
a consult but I have been told by Medicare that it cannot be because the pt will not be returning to the ER doc for further treatment.

Any and all info will be greatly appreciated

Thanks
 

csamps/CPC

Contributor
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I would suggest to your docs the use of ER Dept visit E/M codes 99281- 99285. If you use these, make sure you get the place of service as the ER. Hope this helps!
 

maddismom

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ER consult

If the consult request, opinion, and reply were properly documented, you would code it as an outpatient consult visit at the appropriate level (please see Office or Other Outpatient Consultations in your CPT). You are lucky; many IM teams fail to notify their coders that they've been called in for a consult because an admit was not done and revenue gets lost. I'm not sure why Medicare is not paying your claims.
 

mmallette

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I have always used outpatient consult codes for ER and get paid, but you do need to put the ER doc as referring phys.
 

ARCPC9491

True Blue
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Often times our Interal Medicine Physicians are called to the ER by the ER doc
for a patient they think needs admitted. Once our doctors sees the patient he decides otherwise and sends the pt home. Our doc's want to code this as
a consult but I have been told by Medicare that it cannot be because the pt will not be returning to the ER doc for further treatment.

Any and all info will be greatly appreciated

Thanks

I don't think a consult should be billed either nor a ER visit. The ER doc billed for the ER visit, and only one physician can bill these codes per day, which is normally the ER doc because they are the first to get to the patient. If 2 ER visits are billed same day, same dx, different docs, usually the doc who gets the claim in first gets paid. I don't think the consult should either because the referring physician is usually the one who makes the ultimate call in the care of that patient. ER "consults" are much rather "referrals" - the ER doc is passing the buck. I get this scenario a lot when the ER calls, say the general surgery service - this isn't "truly" a consultation - it's a referral to the "service" - the ER doc isn't asking the professional/advice or opinion, they usually already know and they will no longer be involved in the care of the patient.

In your case, you should bill established outpatient codes, 99211-99215 with place of service ER or Outpatient. I understand the ER doc may be calling and asking for your doc's advice but there's more to a consultation that just that.

I use this table a lot:

Consult:
o Suspected problem or know problem
o Undetermined course of tx
o Written request for opinion/advice from referring provider, including the reason for consultation
o Written opinion returned to referring (telephone calls are sufficient, but need to be documented)
o Referring physician will decide who will manage care
o Patient advised to follow up with referring physician
o Final diagnosis is probably unknown
o Recommended Documentation: Please examine patient and provide me with your opinion

Referral:
o Known problem
o Prescribed and known course of treatment
o Transfer of partial or total patient care for the specific problem
o Appointment made by patient
o No further communication required with referring provider (or limited contact)
o Physician is managing the known problem from the beginning
o Patient advised to return for continuation of treatment
o Final diagnosis typically known at time of referral
o No written letter or report required
o Recommended Documentation: Patient referred to your office for evaluation and treatment



Just my 2 cents :)
 
Last edited:

tammyboyer

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wow.....MC says no to consult? i see that as consult. ER Doc "thought" patient might need admitted and requested your guys opinion and called him in!! Your guy gives his opinon and sends pt home. i see this as consult
 
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