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Education for ER coding.

  1. Default Education for ER coding.
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    I just need to know the correct way of coding an ER visit.

    Doctor is requested for a consult in the ER, patient is NOT admitted. Does he use an ER visit code or an outpatient consultation code?

    If patient IS admitted under doctor's care, then I understand that he would use an admission charge.

    I am just confused as to whether it is an ER code or an outpatient code. I look at the POS being ER and want to do an ER code.

    Any help or suggestions in the matter would be appreciated.

  2. #2
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    You should bill the Consult codes if it's a request for consultation. Which for Orthopedics usually is the case.

    As I understand it, it's usually the ER doc's who bill the actual ER codes.

    I work for an Orthopedic office and we rarely use the ER codes, we use the consult codes in the ER.

  3. Default
    The other flip side of the coin is this: Patient follows-up with the hand specialist after closed reduction. Docs belong to the same facility. I thought that since they both are ortho specialists from the same facility that the follow-up doc should code 99024 since it would be during 90-day global period.

    Is this correct?

  4. Default
    The initial consulting doc wants to use an inpatient consultation charge for an ER as he states that they are inpatient to the ER department. I do not think this is correct.

    So instead of ER codes, use Office or Other Outpatient Consultation charges if patient is not admitted.

    If he admits patient, then it is an admission charge.

  5. #5
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    Quote Originally Posted by nikkisgranny View Post
    The other flip side of the coin is this: Patient follows-up with the hand specialist after closed reduction. Docs belong to the same facility. I thought that since they both are ortho specialists from the same facility that the follow-up doc should code 99024 since it would be during 90-day global period.

    Is this correct?
    Yes, if a procedure was performed and then the patient follows up with another physician of the same group it would be included with the original procedure. However, if the second physician performed a procedure in the OR it is billable.

  6. #6
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    Quote Originally Posted by nikkisgranny View Post
    The initial consulting doc wants to use an inpatient consultation charge for an ER as he states that they are inpatient to the ER department. I do not think this is correct.

    So instead of ER codes, use Office or Other Outpatient Consultation charges if patient is not admitted.

    If he admits patient, then it is an admission charge.
    If the patient has not yet been admitted, you should use the Consult codes/outpatient codes. It get's tricky especially when the doc's see the patient in between the ER and the patient being admitted.

    I was told that if the patient is seen in the ER and admitted that day that we can bill either a outpatient consult(99242-99245) or an inpatient consult(99251-99255), and if we admit the patient, then bill the admit codes (99221-99223).

    Hope this helps!

  7. Default
    Yes. Finally someone that gives me direct answers.

  8. #8
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    Default ER Consult vs Admission
    Quote Originally Posted by jenpollock View Post
    If the patient has not yet been admitted, you should use the Consult codes/outpatient codes. It get's tricky especially when the doc's see the patient in between the ER and the patient being admitted.

    I was told that if the patient is seen in the ER and admitted that day that we can bill either a outpatient consult(99242-99245) or an inpatient consult(99251-99255), and if we admit the patient, then bill the admit codes (99221-99223).

    Hope this helps!
    Actually .... If patient is seen in ER it is an OUTPATIENT consult 99241-99245 (I'm just going to assume that it is really a consult for now vs a new patient visit.)

    If patient is admitted to the Ortho service, then you can code EITHER the consult (I'd use outpatient if that's where you performed the service) OR the admit (99221-99223) but NOT both.

    CPT clearly states that if you see the patient in an outpatient/office setting and later admit on the same date for the same purpose you roll all the work performed into the admit code. However, I have been at conferences where it's recommended that you bill the outpatient consult and NOT bill the admission.

    And don't forget your -57 modifier for "decision for surgery" if you are also going to provide fracture care (even if it's a closed reduction, because all fracture care carries a 90-day global).

    F Tessa Bartels, CPC, CPC-E/M

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