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ER to Inpatient

  1. #11
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    Medical Coding Books
    Quote Originally Posted by deyoung View Post
    I am trying to understand this, so if a patient is seen in the ER and admitted:
    The consultant (just a consultant, not admitting doctor) would bill an OP consult code even though the status changed to inpatient? I would think it would be an inpatient consult code since the hospital changed the status to inpatient.

    Anyone, please share your thoughts.

    Thanks!
    I think that it would depend on whether or note the consult was done before or after the admit. If done before, then as Rebecca states above, the criteria for o/p consult codes have been met and you would use those. Inpatient consults would be for a consult in the inpatient setting, after the patient has been admitted. Is that what you mean?

  2. #12
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    Hi Leslie,

    Thanks, so, for example (non-Medicare): patient is seen by consultant in ER on 03/02/10, another doctor admits the patient on 03/02/10, the hospital changes the status to inpatient admission date of 03/02/10 (i.e., patient was admitted from ER and is an inpatient from 03/02/10 to 03/05/10), consultant would bill from the outpatient consult series 9924x?

    Thanks!
    Donna E. Young, CPC

  3. Default
    Yes, as long as that payor accepts the consult codes.

    Quote Originally Posted by deyoung View Post
    Hi Leslie,

    Thanks, so, for example (non-Medicare): patient is seen by consultant in ER on 03/02/10, another doctor admits the patient on 03/02/10, the hospital changes the status to inpatient admission date of 03/02/10 (i.e., patient was admitted from ER and is an inpatient from 03/02/10 to 03/05/10), consultant would bill from the outpatient consult series 9924x?

    Thanks!

  4. Default 100% agree
    Quote Originally Posted by LTibbetts View Post
    Donna, actually, as I understand it, if a patient was consulted in the ER, and the patient is then admitted to inpatient status (not OBS) by the attending physician (not the consulting physician), the attending charges the initial inpatient code with AI modifer and the consulting doc would also charge an initial inpatient visit with no modifier, unless a surgery was planned. If the patient had a consult in the ER but was then discharged, then the consulting doc would charge an ER visit.

    If pt was admitted to OBS but had a consult while still in the ER, then the consulting doc would charge a new office visit, if they have never seen that patient. If they have seen this particular patient before, then it would be an est patient visit that they would use for the consult. Hope this helps. I know the new consulting codes are confusing. These rules only apply to Medicare patients, however. Some payers may also change their consulting coding guidelines, so you might want to check with them first before billing consults.

    Just wanted to mention I agree 100% with the above note from LTibbetts. I code for Gastroenterologists who consult the ER/Hospital, and this is exactly how we code. We are never the admitting doctor so we never need the AI modifier, but once that patient turns IP, we code as IP.

    And agreed the consulting codes are quite confusing as they vary by payer from 99201-99205 (initial new pt), 99211-99215 (initial estab. pt/ subsq. new or estab. pt), 99241-99245 (initial) and 99224-99226 (susq.). -- Also note, if your doctor is NOT the admitting doctor you should not be using 99218-99219 (only used for those physicians who are designating the pt to OBS status)

    Good luck to all coding!

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