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Consult or Observation Code

  1. Default Consult or Observation Code
    Medical Coding Books
    We have some Doctors that would like to be able to charge for going to the ABC Clinic to look at babies that have been discharged from Hospital but are coming back to the ABC Clinic for whatever reason when the nurses there contact us. Often they kids are jaundiced and the nurses want a bilirubin order etc. Would the Doctor charge a consult code in this case or Observation code? This issue is mostly due to "unassigned newborns" that will be seen at another clinic in the valley but the Doctor there can't call in a bilirubin order as he'she has no privileges to do so.

  2. #2
    Consults are only billable if patient was referred by another physician and a report is being sent to that physician. If this is not happening, I would bill an outpatient visit code (99212-99215) depending on level of care.

    Ruth Ann
    Accucode Medical Billing

  3. #3
    Milwaukee WI
    Default Nurse CAN request consult
    Actually consults can be requested by "A physician or other appropriate source" (CPT 2009 professional edition, page 14, right column under Consultations).

    However, I still think Ruth is correct that you have new patient visits, or admit to observation (if that's the case).

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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