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Consult or 90801?

  1. #1
    Question Consult or 90801?
    Medical Coding Books
    Our psychiatrists provide a consult service for the ER. The ER has a separate area for psych patients. There are 2 scenarios:

    1. Patient goes into a medical room (not the separate psych area), seen by ER Dr because they may have physical conditions, then if needed he requests a psych consult to eval for mental condition.

    2. Patient comes in, triaged by nurse, sends patient to psych area to be evaluated. After psychiatrists eval's patient then needs to be cleared by medical doctor.

    Our psychiatrists have been billing 90801 for both scenarios. We recently been looking into using E/M consult codes to see if those would be more appropriate for the ER. The more I dig into this the more I think we 90801 may be the most appropriate.

    Please share your thoughts.
    Donna E. Young, CPC

  2. #2
    Jacksonville River City FL
    Our psychiatrists use E&M codes for consults requested in ER or other medical units as well as out-pt consults when there is a medical question. A note of caution - make sure documentation supports an E&M code since 90801 documentation is often very different.

  3. #3
    Thank you for the response. Do you, or anyone out there, have patients that come into the ER and stay for a day or so after they come in? Our Dr's do a follow-up visit the next day and aren't sure how to bill that. I spoke to another coder that said to use the estabilished outpatient visit codes (the ED Dr would most likely be using the ED codes).

    Donna E. Young, CPC

  4. #4
    I am not sure I am following correctly but what I get is ER doc sees them and the patient stays a day or 2..? Stays where? If it is inpatient, then bill 99231-99233 if they are outpatient status bill 99211-99215

  5. #5
    Thanks, they wouldn't be inpatient. Still in ER area.
    Donna E. Young, CPC

  6. #6
    Jacksonville River City FL
    For subsequent visits in ER/Observation we use established patient, outpatient visit - code range 99211-99215. However, if they come in through ER but are then admitted as full In-Patient, the subsequent visits would be coded as 99231-99233.
    Your code is always driven by the place of service assigned by the hospital. Patients are probably not officially listed as ER status if they remain several days - the hospital likely has converted them to Observation.

  7. #7
    Default E/M vs Psychotherapy notes
    I have a question what is the diference between E/M notes vs psychotherapy notes?

  8. #8
    Quote Originally Posted by NANASIA View Post
    I have a question what is the diference between E/M notes vs psychotherapy notes?
    EM notes are more basic notes regarding the status of a patients illness. Psychotherapy notes are very detailed, personal notes that are highly confidential. May contain very intimate info such as dreams, sexuality, etc etc

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