Hospital Consultation in Observation

tracylc10

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Good morning all,

I have an MD who saw a patient for a consultation in hospital observation. I am aware that Medicare does not cover hospital consultations. I am being advised by our chief MD that I should code with a New pt E/M 99201-99205. Pt has been seen in our office, but it was back in 8/2014. Here is the note. How would you code it?


Consultation Report


Labor History and Physical



LMP:11/20/2016 EDD: 08/27/2017



EGA: 10.3wks



Reason for Admission: Patient is a 32yo G3P2 at 10.3wks with 1 month history

worsening left leg pain and swelling. The patient reports transition to

sedentary work in the last few months and has prolonged episodes of

immobilization. Patient denies dyspnea, chest pain, bleeding, abdominal pain,

dysuria, hematuria and nausea.



Labs:

Chemistry Comprehensive - Last 36 hours (17) Result Date/Time

Sodium Lvl 137 01/31 23:44

Potassium Lvl 3.8 01/31 23:44

Chloride Lvl 105 01/31 23:44

CO2 24 01/31 23:44

Glucose Level 75 01/31 23:44

BUN 15 01/31 23:44

Creatinine Lvl 0.73 01/31 23:44

AGAP 12 01/31 23:44

Total Protein 6.9 01/31 23:44

Albumin Lvl 3.2 01/31 23:44

Calcium Lvl 9.3 01/31 23:44

Bili Total 0.4 01/31 23:44

Alk Phos 76 01/31 23:44

AST 20 01/31 23:44

ALT 27 01/31 23:44

GFR African Am >60 01/31 23:44

GFR Non AfrcnAm >60 01/31 23:44



Hematology Basic - Last 36 hours (24) Result Date/Time

WBC 10.93 (H) 01/31 23:44

RBC 4.13 01/31 23:44

Hgb 11.8 01/31 23:44

Hct 35.0 01/31 23:44

MCV 84.7 01/31 23:44

MCH 28.6 01/31 23:44

MCHC 33.7 01/31 23:44

RDW-CV 12.3 01/31 23:44

Platelet Count 255 01/31 23:44

MPV 9.2 01/31 23:44

NRBC Auto Rel 0.0 01/31 23:44

NRBC Auto Abs <0.01 01/31 23:44

Neutrophil Rel 70.4 01/31 23:44

Lymphocyte Rel 20.3 01/31 23:44

Monocyte Rel 6.6 01/31 23:44

Eosinophil Rel 1.9 01/31 23:44

Basophil Rel 0.5 01/31 23:44

Imm Gran Rel 0.3 01/31 23:44

Neutrophil Abs 7.70 01/31 23:44

Lymphocyte Abs 2.22 01/31 23:44

Monocyte Abs 0.72 01/31 23:44

Eosinophil Abs 0.21 01/31 23:44

Basophil Abs 0.05 01/31 23:44

Imm Gran Abs 0.03 01/31 23:44





PMH: DVT - now



PSH: n/a



OBGYN: SVD x 2 no complication no std no abnormal pap



GYN: (See Printed Prenatal Record)



All: NKA Soc: Negative x 3 Meds: Prenatals



PREGNANCY COMPLICATIONS: Above.



Vital Signs: Last Charted: 24 Hr Minimum: 24 Hr Maximum:

Temp F 98.3 (02/01 07:56) 98.3 (02/01 07:56) 98.1 (01/31 21:21)

Heart Rate 67 (02/01 07:56) 67 (02/01 07:56) 94 (01/31 21:21)

Resp Rate 16 (02/01 07:56) 16 (02/01 07:56) 20 (02/01 03:26)

SBP 118 (02/01 07:56) 106 (02/01 03:08) 151 (H) (01/31 21:21)

DBP 73 (02/01 07:56) 55 (L) (02/01 03:26) 84 (01/31 21:21)

SpO2 100 (02/01 07:56) 96 (02/01 03:08) 100 (02/01 07:56)

BMI 42 (02/01 03:52)

Hematology Basic - Last 36 hours (24) Result Date/Time

WBC 10.93 (H) 01/31 23:44

RBC 4.13 01/31 23:44

Hgb 11.8 01/31 23:44

Hct 35.0 01/31 23:44

MCV 84.7 01/31 23:44

MCH 28.6 01/31 23:44

MCHC 33.7 01/31 23:44

RDW-CV 12.3 01/31 23:44

Platelet Count 255 01/31 23:44

MPV 9.2 01/31 23:44

NRBC Auto Rel 0.0 01/31 23:44

NRBC Auto Abs <0.01 01/31 23:44

Neutrophil Rel 70.4 01/31 23:44

Lymphocyte Rel 20.3 01/31 23:44

Monocyte Rel 6.6 01/31 23:44

Eosinophil Rel 1.9 01/31 23:44

Basophil Rel 0.5 01/31 23:44

Imm Gran Rel 0.3 01/31 23:44

Neutrophil Abs 7.70 01/31 23:44

Lymphocyte Abs 2.22 01/31 23:44

Monocyte Abs 0.72 01/31 23:44

Eosinophil Abs 0.21 01/31 23:44

Basophil Abs 0.05 01/31 23:44

Imm Gran Abs 0.03 01/31 23:44



Imaging:

Radiology - Last 36 hours (1)

US LE Venous Duplex Left (01/31 23:36)

IMPRESSION:

EXTENSIVE DVT THROUGHOUT THE LEFT LOWER EXTREMITY FROM THE COMMON FEMORAL TO

THE PROXIMAL CALF VEINS.



PE:

Heart: RRR

Lungs: CTA

Abdomen: GRAVID

Contractions: n/a

Pelvis: Dilation def Effacement: _ Station: _ Presentation: _

EFW: n/a

FHT: pending

EXT: Swollen Left leg with erythema on medial aspect of the upper thigh.

Membranes: intact

Fluid: n/a



Assessment: 32yo with Left Leg DVT and pregnancy at 10.3wks.





Plan: 1. Continue Lovenox as prescribed. 2. PE precautions reviewed with

patient. 3. Follow up with me in 1 week for Continuity of care confirmation

of pregnancy and dating. After confirmation she will be referred to MFM for

consultation and coordination of high risk prenatal care.




Thank you in advance for any advice.
 

thomas7331

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If the patient was seen by that provider (or another of the same group & specialty) in the office in 8/14, it's less than 3 years so they couldn't be coded as a new patient. If it's a Medicare patient, or a payer that doesn't recognize consults, I would code this visit as 99214. If it's a commercial payer that does accept consults, and assuming the record includes the necessary documentation of a consult request and report, then I would code it as 99243.
 

tracylc10

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New Braunfels, TX
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If the patient was seen by that provider (or another of the same group & specialty) in the office in 8/14, it's less than 3 years so they couldn't be coded as a new patient. If it's a Medicare patient, or a payer that doesn't recognize consults, I would code this visit as 99214. If it's a commercial payer that does accept consults, and assuming the record includes the necessary documentation of a consult request and report, then I would code it as 99243.



Thank you so much Thomas. This is exactly what we decided on after I explained that it really was not a new pt. We ended up coding a 99214 as the patient does have Medicaid.
 
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