Question Place of Service for Surgery Consults at the Hospital

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Hello. I recently started working for a surgeon. This is my first time coding for a physician that sees patients in a hospital setting. He is on call and sees patients in the ED, ICU, etc..I am often unclear on which place of service to choose for his E/Ms. He mostly does surgery consults. Sometimes the patient paperwork states they have been admitted, but they appear to still be in the ED. Is the POS automatically 21 after the patient is admitted or is it truly dependent on what part of the hospital the patient was seen (23)? Any help greatly appreciated.
 

Orthocoderpgu

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Two things. The POS is going to depend on the final discharge status of the patient. If the patient comes in through the ER but gets admitted to inpatient status, then the visit is inpatient. Second, just because your doctor is asked to see a patient does not make it a consultation. A true "consultation" is rare. In the very rare event that a true consultation does happen most insurance companies will not allow consultation codes to be submitted any longer and there is a reason for that.
 
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Hi Orthocoderpgu, thanks for the quick response. I do not bill his services using the consult codes as I understand that they are almost never appropriate. I appreciate the clarification on the POS!!
 

Orthocoderpgu

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Hi Orthocoderpgu, thanks for the quick response. I do not bill his services using the consult codes as I understand that they are almost never appropriate. I appreciate the clarification on the POS!!
I'm grateful for that. So going forward lets not use the word "consultation" unless that is what you are actually speaking of? I know doctors use this term incorrectly all the time, but they are using the word a different way than coders do so that's fine.
 

SharonCollachi

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Two things. The POS is going to depend on the final discharge status of the patient. If the patient comes in through the ER but gets admitted to inpatient status, then the visit is inpatient. Second, just because your doctor is asked to see a patient does not make it a consultation. A true "consultation" is rare. In the very rare event that a true consultation does happen most insurance companies will not allow consultation codes to be submitted any longer and there is a reason for that.

Just for my curiosity, as so far I am not billing this sort of thing... wouldn't the patient status on the date of the service determine which pos it was? For instance, if they were in the ER for two days, and on day one you saw the patient in the ER, would the POS not be the ER? Would you not be stuck waiting to see if the patient was later admitted, or was later in observation status, or what-have-you?
 

Orthocoderpgu

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Just for my curiosity, as so far I am not billing this sort of thing... wouldn't the patient status on the date of the service determine which pos it was? For instance, if they were in the ER for two days, and on day one you saw the patient in the ER, would the POS not be the ER? Would you not be stuck waiting to see if the patient was later admitted, or was later in observation status, or what-have-you?
Sharon the problem is that what you said...makes sense. That just can't happen. If the patient came into the ER and discharged from the ER everything is fine with an ER POS. Most patients go from the ER to observation, outpatient or inpatient status. When the hospital sends in their bill for the facility charges the POS is going to be whatever the ultimate status of the patient was. Let's say inpatient. The physician bill needs to match the facility POS or it will be denied due to a POS mismatch.
 
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