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
- ICD-10 Trainings
- Comprehensive Courses
- CPC (Certified Professional Coder)
- COC (Certified Outpatient Coder)
- CIC (Certified Inpatient Coder) NEW!
- CRC (Certified Risk Adjustment Coder) NEW!
- CPB (Certified Professional Biller)
- CPMA (Certified Professional Medical Auditor)
- CDEO (Certified Documentation Expert – Outpatient) NEW!
- CPPM (Certified Physician Practice Manager)
- CPCO (Certified Professional Compliance Officer)
- VIEW ALL CERTIFICATIONS
Coding / Billing Solutions
- Audit / Compliance Solutions
Job Experience / Apprentice Removal
News / Discussion
- Other Resources
- Book Store
- Log In / Join