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Intraoperative consult code ?

  1. #1
    Default Intraoperative consult code ?
    Medical Coding Books
    Could someone please let me know how to bill for an intra-operative consult. We have run across 2 different cases. 1. would be if our Dr was call in during surgery for a consult on something and no surgery was performed by our Dr. 2. would be when like the one I have now where our Dr was called in by the operating Dr. for a consult and our Dr. removed the spleen and did a colectomy. Our Dr. wants to get paid for the consult as well as the surgery.
    Thank you for any advise
    Marie

  2. #2
    Location
    Milwaukee WI
    Posts
    4,466
    Default Consult code
    Scenario 1: Intraoperative consult where consulting physician does NOT perform any surgery. Bill the appropriate consult code, according to documentation. (Could be inpatient or outpatient depending on patient's hospital admit status vs day surgery). Read my NOTE at the end of this post.

    Scenario 2: IF your physician was called to consult and made a decision for surgery, which he then performed, then yes, you could code the consult (with a -57 modifier) and the surgery. Read my NOTE at the end of this post
    BUT ...
    IF your physician was called in because the case was too complex for one surgeon to handle, then there is no consult.

    NOTE: In my experience, it would be a rare day, indeed, to see documentation that actually supported an intraoperative consult. I rarely see any history documented and physical exam is necessarily very limited by the necessity to maintain a sterile operative field, and the patient's anesthetized condition. Not saying it never happens ... it's just very rare. In that case you have a 99499 Unlisted E/M.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC
    Last edited by FTessaBartels; 04-02-2009 at 02:26 PM.

  3. Default
    I usually have trouble billing for these as well but I think the op note below is a good example of one that could be billed based on time. My physician did not do the closure he recommended so I billed only the consult code. If had scrubbed in and performed a procedure, I probably would only bill the for the procedure (but I'm not sure if that's correct or not).

    DESCRIPTION OF CONSULT: I was consulted intraoperatively on a 68-year-old
    woman who was undergoing repair of a large para-esophageal hernia via
    laparoscopic approach. At the time of operation, a Morgagni hernia was
    identified and I was asked to consult intraoperatively regarding management
    options for this. At the time of arrival, the laparoscopic Nissen
    fundoplication had been completed and an examination of the Morgagni was
    undertaken. The transverse colon had been herniated in this but was removed
    by the time of my arrival. There was no imaging immediately available for
    review. The hernia appeared to be a classic Morgagni hernia that extended
    for approximately 6 cm transversely. With decreasing the insufflation
    pressure and manipulation with the instruments, it appeared that the
    diaphragmatic rim of the hernia would reach the anterior costal margin
    without substantial tension. I, therefore, recommended a primary closure
    with nonabsorbable suture at this juncture. The rim of the hernia sac was
    incised. During suture placement, there was a breach of the parietal
    pleural layer and a pneumothorax developed which was drained
    laparoscopically by incising the pleura further to allow egress of air at
    the end of the case. After a suture was placed and it did appear that the
    hernia would be adequately closed, I did not recommend a drain placement at
    this point outside of suctioning out the chest. I spent 30 minutes
    coordinating the intraoperative care and decision making for this patient

    Lisi, CPC

  4. #4
    Location
    Milwaukee WI
    Posts
    4,466
    Default I think you're right
    Lisi,
    This is truly a great note (unlike most of the ones I've seen). I think you definitely could code 99253 based on time spent (or 99243 if this was an outpatient surgery).

    I will say, though, that from the dictation I can't tell that your surgeon didn't actually perform the closure himself. But if you know for a fact that he didn't do the procedure but was primarily advising and offering his professional opinion/advice, then definitely go for the consult.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  5. #5
    Default
    To bill based on time is generally because conseling and/or coordiantion of care is more than 50% of the visit. Definitely not counseling the patient (who is under) can this be considered co-ordination of care?
    Rachel C. Ashley, CPC-E/M
    Houston, TX

  6. #6
    Location
    Milwaukee WI
    Posts
    4,466
    Default Coordination of care
    Quote Originally Posted by rcashley View Post
    To bill based on time is generally because conseling and/or coordiantion of care is more than 50% of the visit. Definitely not counseling the patient (who is under) can this be considered co-ordination of care?
    Yes, definitely, it is coordination of care. The same rules apply.

    F Tessa Bartels, CPC, CEMC

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