Wiki Specialist consult in er

[cheyenne102]

If a specialist is called in by the ER provider as a "consult". The specialist performs everything need to select a consult E/M level. The specialist consults and leaves he does NOT admit the patient.

I know some insurances still pay the consult codes (99241-99425). Medicare doesn't - so can I bill a (99201-99215) for that visit for Medicare patients?? Also if I submit (99241-99245) to all other insurances will they automatically cross-walk it (99201-99215) if they do not pay consult codes.

Thanks for your help
Totally Frustrated

 

[sullivak]

Yes, you can bill the 99201-99215 range for Medicare with the ED place of service 23. Similarly, you can bill the 99241-5 range to other carriers, but I doubt they'll do you the favor of crosswalking it if they don't cover consult codes. You'll have to check the individual carrier's policy on that.

 

[sullivak]

I was totally wrong on this. You can't bill the 99201-15 range for Medicare. Debra Mitchell pointed out in a different post that you must use the ER codes for a consult in the ED for Medicare. Here's the text I found about it online -

According to CMS Transmittal 1875 "If the ED physician requests that another physician evaluate a given patient, the other physician should bill an emergency department visit code. If the patient is admitted to the hospital by the second physician performing the evaluation, he or she should bill an initial hospital care code and not an emergency department visit code."

Sorry if I led you astray!