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Consult VS Admit

  1. #1
    Dickson, TN
    Default Consult VS Admit
    Medical Coding Books
    Ok-- Here's the scenario:

    Specialty provides consult in ED. Specialtiy service admits this patient as an inpatient. Were going to take to surgery, follow and then d/c this patient home? Would you bill an admit or a consult?

    Does it matter wher the patient came from? Ed, our office, etc?


  2. #2
    I would bill this as an admit with a 57 modifier. ED most likely intended to transfer care which doesn't meet the requirements for a consult. This of course is based on CMS guidelines.

    An outpatient consult even in the facility side is going to reimburse a little higher than the admits but you still have to meet all the requirements for a consult. I saw a post where the AMA has broadened the description of consults, seems like they are saying screw you to CMS to me, but that doesn't take effect until next year.

    Just my opinion,

    Laura, CPC, CEMC

  3. #3
    Laura, is there any chance that you remember where you saw that post? I would like to read it. I am a little (well, maybe a lot) confused about all of these changes happening in consult coding. Use them-don't use them, CMS rules-non-CMS payers rules, etc. I could use all of the help I can get....

  4. #4
    Default Tessa posted it

    I still don't have my 2010 CPT book yet but I have asked to purchase an audio conference about it. We will see if the budget allows. I received an email about it, have no idea if it will be good or not but the link below is it if anyone is interested.

    Laura, CPC, CEMC

  5. #5
    Milwaukee WI
    Default CPT tells us to bill initial hospital
    I agree with Laura - bill as 99221-99223 with -57 modifier.

    Even the current CPT states: When the patient is admitted ito the hospital as an inpatient in the course of an encounter in another site of service (e.g. 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. Source: 2009 CPT Professional Edition, guidelines under Initial Hospital Care, page 12, top of 2d column

    2010 CPT professional edition has the exact same guidance ... only on page 14.

    I get my CPT directly from AMA.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC
    Last edited by FTessaBartels; 11-09-2009 at 01:28 PM.

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