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Thread: Er consult? Or outpatient

  1. #1

    Default Er consult? Or outpatient

    AAPC: Back to School
    Hello everyone, I am having a hard time coding Er consultation this is the scenario for today:

    Patient went to see his primary Dr. for weakness and stumbling. PCP decided to sent him to ER, he was found to have drug poisoning he was observed there for 6 hrs. due to altered mental status. Per ER doctor he feel is safe to send him home after a fairly good effective observation and that he will follow with PCP. Now, Dr. want to bill 99245 (consult) What do you guys think about this one? I would bill an outpatient... Do you agree???
    Mildred Nieves, CPC

  2. #2
    Join Date
    Apr 2007
    Milwaukee WI

    Default Which doctor?

    Which doctor are you talking about?

    The PCP should be billing his Established patient visit.

    The ER doctor should be billing ER visit code.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. #3


    Thanks for your reply, The ER doctor is charging the consult, patient only spend 6 hours on observation. Do you agree with code 99234 or should I bill outpatient 99203? Since patient discharge on same day (less 24hrs.)
    Mildred Nieves, CPC

  4. #4
    Join Date
    Apr 2007
    Tuscaloosa, AL


    The ED doctor should code 99281-99285. OR IF the patient was admitted and discharged from observation on the same date the code would be 99234-99236.


  5. #5
    Join Date
    Apr 2007
    Columbia, MO


    I agree with Jerri IF the physician wrote an order for admit to observation, however if the patient was kept in the ER as an ER patient (which is typically what happens) the the physician should be using an ER visit level 99281-99285.

    Debra A. Mitchell, MSPH, CPC-H

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