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ER Visit with Pending Admit

  1. Default ER Visit with Pending Admit
    Medical Coding Books
    I am confused about billing in or outpatient codes with ER Consult or NP Visits. I know that coding material that I have read says to bill as an OP if you see the patient in the ER, but many of our patients are in the process of being admitted. Many times they are being admitted by another physician so they end up to be an inpatient. Our doctors often see patients in the emergency who are going to be admitted by another physician because of the overcrowding, and we do not have an immediate bed available. Also, I have found that when I bill an outpatient code for a patient that ends up to be admitted many insurance companies do not recognize the place of service 22 or 23 with the outpatient NP Consult or NP visit codes. They keep trying to get me to bill a ER visit code, which is usually billed the the ER doctors.

    I would appreciate any thoughts.

    Thanks,

    De

  2. #2
    Location
    Milwaukee WI
    Posts
    4,466
    Default Who is requesting the consult
    Who is requesting the consult? If the ER physician is requesting the consult then I'd code the outpatient consult with POS 23.

    If it's the admitting physician who is requesting the consult, then I'd code the inpatient consult code IF you're sure the patient is being admitted that same day,even though you are seeing the patient in the ER because the hospital hasn't a bed for admission yet. If they don't actually get admitted until the next day, then I'd go back to the outpatient consult codes.

    I'd appeal your denials with documentation.

    What specialty are you coding for? You might want to post this question on THAT thread (e.g. gastroenterology) ... most of the responders on this ER thread will be coding for ER (doctors or facility).

    F Tessa Bartels, CPC, CEMC

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