Results 1 to 5 of 5

ER consult ?

  1. #1
    Default ER consult ?
    Medical Coding Books
    Per CPT guidelines " When a patient is admit to the hospital as an inpatient in the course of an encounter in another site of service (ER) all e/m services provided by that physician is conjunction with that admission are considered part of the initial hospital care when performed on the same date as the admission. "

    Question ?
    Patient presents to the ER for abd pain. ER doctor calls surgery for consult. CT shows cholecystitis.Surgery see's pt in ER. Surgery decides to admit patient and bring to OR next day.

    My doc what's to bill inpatient cosult instead of admit. I would say i have to bill either admit or office consult since the consult took place in the ER. Would this be correct ?

  2. #2
    Location
    Louisville, KY
    Posts
    1,101
    Default
    If the surgeons make a decision to admit, then they are assuming care of the patient--hence, this is no longer a consultation. If a provider elects to admit, that professional service takes precedence over any "consultative" services furnished during the encounter.

    If the consult occurred before the patient was admitted, the POS would be OP anyhow.

    Hope this helps.

  3. #3
    Default
    Quote Originally Posted by kevbshields View Post
    If the surgeons make a decision to admit, then they are assuming care of the patient--hence, this is no longer a consultation. If a provider elects to admit, that professional service takes precedence over any "consultative" services furnished during the encounter.

    If the consult occurred before the patient was admitted, the POS would be OP anyhow.

    Hope this helps.
    So would it be accurate to code just the admit with -57 ?

  4. #4
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    I agree with Kevin...and yes mod -57 would be applicable.
    Lisa Bledsoe, CPC, CPMA

  5. #5
    Location
    Milwaukee WI
    Posts
    4,466
    Default Admitted the next day?
    Was the patient admitted immediately or did the patient leave the ER to return the next day for admission & surgery?

    If admitted the same day, directly from ER ... then code the admission w/ -57 modifier. (CPT clearly tells us to include all the work done in the admission code.)

    If ER consult performed and patient sent home to return next day for surgery ... then code the appropriate OP consult w/ -57 modifier. Do NOT code the admission H&P which will still need to be performed on day of surgery.

    And, Kevin, in principle I disagree with your statement "If the surgeons make a decision to admit, then they are assuming care of the patient--hence, this is no longer a consultation." Whether it is a consult is dependent on the intent of the requesting physician, not the decision of the consultant as a result of his/her evaluation & examination of the patient. It was still a consultation ... but we roll in into the admission per CPT guidelines. (Semantics, I know ...)

    F Tessa Bartels, CPC, CEMC

Similar Threads

  1. ER Consult vs Inpatient Consult
    By lcouto in forum Emergency Department
    Replies: 1
    Last Post: 10-22-2015, 11:08 AM
  2. E/M OBV Consult converted to Inpt Consult
    By AmandaHartman in forum E/M
    Replies: 1
    Last Post: 06-13-2014, 11:36 AM
  3. Billing OV Consult vs Hospital Consult
    By crowemd in forum Auditing General Discussion
    Replies: 1
    Last Post: 02-20-2012, 03:02 PM
  4. IP consult
    By cchilva in forum E/M
    Replies: 3
    Last Post: 06-16-2009, 07:32 AM
  5. Replies: 1
    Last Post: 01-24-2008, 02:16 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.