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In pt vs Out pt consultations

  1. #1
    Default In pt vs Out pt consultations
    Medical Coding Books
    Does anyone know where I could find written information on how to determnines an in vs out pt consult.

    For example, when our surgeon comes to the ER at the request of the ER Dr, and the pt is admitted by the surgeon. Is this considered an In pt consult, or an outpt consult?

    Thank you.

  2. #2
    Modesto, CA; Central Valley Chapter
    If the consult is done prior to the admit I would say it is outpatient; if the consult resulted in the patient being admitted, I would say it is outpatient. If the patient was admitted, then the consult took place then it is an inpatient consult.

    hope this helps!

  3. #3
    Is this really a consult? Is opinion or advice being rendered back to the ER Doc? It's my understanding that these aren't consults, but rather outpt visits or initial hospital visits.

  4. Default
    Would this not be an admit charge since the surgeon admitted the patient? Under initial hospital care it states "When the patient is admitted to the hospital as an inpatient in the course of an encounter in another site of service (eg, hospital emergency department...) all evaluation and management services provided by that physician in conjunction with that admission are considered part of the initial hospital care when performed on the same date as the admission." - found under Hospital Inpatient Services of the CPT book. It is my understanding, once the patient is admitted then it does qualify as a consult due to the surgeon has taken over care of the patient and this does not qualify as a consult.

    if the patient is not admitted, then it is an outpatient consult as long as the ER doctor is needing the doctor's opinion-found under Office or Other Outpatient Consultations of the CPT Book. for codes 99241-99245 "these codes are used to report consulations provided in the physician's office or in an outpatient or other ambulatory facility, including hospital observation services, home services, domiciliary, rest home or emergency department."

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