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Inpt and ER consults

  1. #1
    Default Inpt and ER consults
    Medical Coding Books
    Question. Need for clarification to MD and mangaer.

    If a pt is in the ER for Hip pain and the ER MD does an xray and determine that there is a displaced femural fx. ER MD admits the pt and then calls the orthopedic MD in to treat the fx. Orthopedic MD evaluates the pt and determines that surgery is needed and set up a ORIF. The MD is charging and Inpt consult and the surgery code. Is this correct or should it just be the surgery code because the fx dx was already determined by the ER MD.

    Same scenario but the pt is an Inpt for failure to thrive, while the attending md is evaluating the pt the pt states that their knee hurts. MD then calls the orthopedic md to evaluate the shoulder pain. Ortho evaluated the pt and determines that pt needs an arthroscopy due to chondromalacia. Is this a inpt consult.


  2. #2
    Milwaukee WI
    Default In our hospital
    In our hospital the ER doc never admits. Admission is only to the attending physician ... so scenario # 1 the Ortho doc would be the admitting physician and would code an Initial Hospital Visit (w/ -57 modifier for decision for surgery). Think of it this way ... is the ER doc going to follow the patient and continue to treat throughout the hospital stay? Of course not. The ER doc is focused on the ER and may never see this patient again, so how could he be requesting an opinion on the management of the case?

    The second scenario sounds like it possibly is a consultation request ... asking for an opinion from Ortho about the patient's knee pain. The fact that on evaluation the Ortho doc found a problem that requires surgical intervention doesn't negate the original request for an opinion.

    BUT ... It's difficult to give definitive answers without actually seeing all the documentation. If in scenario # 2 the attending writes in his/her notes that "ortho will be called for knee" that is LESS clear than if the attending's documentation reads "Request consultation from Ortho re persistent knee pain." The first phrasing seems a little more like a transfer of care.

    Hope that helps

    F Tessa Bartels, CPC, CEMC

  3. #3
    In our hospital the er doc is alot of time the admiting md, then they call the PCP and any specialist needed. So really the PCP follows the care of the pt through thier course at the hospital and the specialist, in my case, just does the surgery and then the post op visits in the hospital. Specialist doesn't do the discharge summary the PCP does. How does this, if at all, change things.

  4. #4
    Milwaukee WI
    Default Consult request for opinion
    A consultation is a request from one provider (or other qualified requestor - like a social worker) for advice or opinion on the management of a problem.

    I just don't see how an ER doctor who has "admitted" the patient, but isn't really the attending (who is the PCP) can request any advice on managing a problem s/he has no intention of managing at all. Given, that I don't see a consult.

    It would be cleaner if the surgeon admitted the patient (which would include doing the D/C summary).

    In any case the Initial Hospital visit is not necessarily the same thing as an H&P. What is the ER doc coding? If he is coding the initial hospital visit then your surgeon gets a subsequent hospital visit (-57 modifier as appropriate). If no one else is coding the initial hospital visit, then your surgeon should code that (-57 mod , etc)

    F Tessa Bartels, CPC, CEMC

  5. #5
    I agree with Tessa.

    To me this is pretty straightforward. What is the ED providers intent? Does he want the ortho to take over, or does he want an opinion on what he should do?

    Same thing for your other scenario, just because a specialist is called in to see an inpatient doesn't mean it is a consult. Consults are based on intent ,whether its inpatient or outpatient, doesn't matter.

    Laura, CPC

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