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Wiki Outpatient billing

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mconnolly

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Our cardiologist sometimes sees patients in the cath lab. they are not yet admitted to the hospital but rather in the holding area. The surgeon asks our doctor to consult with the patient, but because of the new medicare consult rules, we cannot bill a consult code. If the patient is still in outpatient status, what code does she bill for her consult. Also, the new EMR rules state the consulting doctor must do an HPI so she wants to bill accordingly. Since the patient is not admitted, I don't believe she can bill 99223, should she bill for observation? This is a medicare patient. Thanks.
 
When the provider is consulting on a patient who is outpatient status you would use the new or established codes 99201-99205, 99211-99215 depending on if the patient is established or not.

Jessica CPC, CCC
 
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