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Emergency Room Consults

  1. #1
    Location
    Knoxville, TN
    Posts
    39
    Default Emergency Room Consults
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    Hello Everyone,
    If a request is made for an orthopedic consultation in the ER and our physician renders this consultation, but then admits the patient would we need to charge for an outpatient consultation or an admission?

    The reason I ask is that my physicians request to bill for an outpatient consult. Sometimes they will admit the patient and do surgery or sometimes they will do a manipuluation in the ER and then admit the patient which makes things even harder because in that case the procedure date and the admit date don't match. When this happens the hospital shows them as the admitting physician. If I'm going to bill an outpatient consult then I need a referring physician and that just isn't readly available.

    I would think that if we are admitting the patient then we need to bill for the admit not the consult, but I like said when they do a consult and surgery on one day and then admit the patient after surgery which is on the next day things don't match up.

    I would appreciate any feedback from others who experience this. Thanks in advance for your help. You guys are the best!
    Christy Brown, CPC
    Humana, Clinical Guidance Coder
    Knoxville, TN

  2. #2
    Default
    the progress note in question can only be used to admit and should be coded with 99221-99223....hope this helps

    Quote Originally Posted by chrislyn1977 View Post
    Hello Everyone,
    If a request is made for an orthopedic consultation in the ER and our physician renders this consultation, but then admits the patient would we need to charge for an outpatient consultation or an admission?

    The reason I ask is that my physicians request to bill for an outpatient consult. Sometimes they will admit the patient and do surgery or sometimes they will do a manipuluation in the ER and then admit the patient which makes things even harder because in that case the procedure date and the admit date don't match. When this happens the hospital shows them as the admitting physician. If I'm going to bill an outpatient consult then I need a referring physician and that just isn't readly available.

    I would think that if we are admitting the patient then we need to bill for the admit not the consult, but I like said when they do a consult and surgery on one day and then admit the patient after surgery which is on the next day things don't match up.

    I would appreciate any feedback from others who experience this. Thanks in advance for your help. You guys are the best!
    Rachele Porter, AS, CPC, CPC-H, CEDC
    no weapons formed against me shall prosper

  3. #3
    Location
    Milwaukee WI
    Posts
    4,466
    Default Is this really a consult?
    Without actual documentation it's hard to give you a definitive answer.

    If this is really a consult - not just the ED doctor saying to Ortho, "Here, you take care of this" - then ...

    If as result of consult patient is admitted same day - you'd bill the admission.

    If decision for major surgery is made at this visit add -57 modifier (yes, closed fracture care w/ manipulation counts as "major surgery" with a 90-day global).

    If Ortho doc is asked to consult, sees patient in ER and manipulates fracture in ER, then later admits due to some post-procedure issue ... I'd code the consult (or appropriate level outpatient code) - your ED physician is the requesting physician.

    You mention that the patient is admitted the next day ... are you talking about cases where the patient arrives late in the evening and the doctor has made the decision to admit but the hospital doesn't get registration done (a bed ready) until after midnight? You code the appropriate level E/M based on the day the service was provided ... even if that means the hospital record "admit" date doesn't match your 99221-23 DOS.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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