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Outpatient consult same day as admission

  1. #1
    Default Outpatient consult same day as admission
    Medical Coding Books

    I have a scenario that requires some clarification:
    A physician plans to admit the patient on a given day. Prior to the admission the patient is seen by a sub-specialist (same facility) at the request of the admitting. Would you bill an outpatient consult for the sub-specialist?
    I found the earlier thread (link below) which is not exactly covering this situation.

    Any insight you could provide is greatly appreciated.
    Karolina, CPC, CPMA, CEMC

  2. #2
    Where was the patient seen, in the office or in the hospital? It shouldn't matter what the other provider did unless the "sub specialty" is not recognized by the carrier and they see them as the same provider.

    So if they were seen outpatient that is what I would use. If they were already in the hospital, the H&P just hadn't been completed, I would use the inpatient codes.

    Laura, CPC, CEMC

  3. #3
    Both docs are hem/oncs but highly specialized. I have no problem coding the consult as a consult - nicely documented, I am just not sure if it is a 99243 or 99253. The office is in the outpatient hospital, the consult was prior to admission. The admitting doc belongs to the same facility. Quite complex and at this point more of hyperthetical interest.
    Thank you very much for your reply, Laura.
    Karolina, CPC, CPMA, CEMC

  4. #4
    If the place of service is not inpatient you would have to use 99243.

    Laura, CPC, CEMC

  5. #5
    Thank you. That was my take on it as well, but I needed a second opinion.
    Karolina, CPC, CPMA, CEMC

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