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proper code?

  1. #1
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    Worcester Ma #50805
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    22
    Default proper code?
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    pt is in emergency Dept. MD surgeon see's pt. while in ED decides to go to surgery is 99284-57 an appropiate code?

  2. #2
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    Normally, the ED physician will report the ED code (99284). Other physicians seeing the patient would report a new/established patient visit code or outpatient consultation code (depending on the date of service and payer effective 1/1/10!). If the patient was seen by an ED physician and you're reporting a separate service for the surgeon where the decision was made to perform surgery either that day or the following day, you would report the appropriate E/M office visit code or consult code and append modifier -57.

  3. #3
    Location
    Worcester Ma #50805
    Posts
    22
    Default
    Quote Originally Posted by jhume View Post
    Normally, the ED physician will report the ED code (99284). Other physicians seeing the patient would report a new/established patient visit code or outpatient consultation code (depending on the date of service and payer effective 1/1/10!). If the patient was seen by an ED physician and you're reporting a separate service for the surgeon where the decision was made to perform surgery either that day or the following day, you would report the appropriate E/M office visit code or consult code and append modifier -57.
    This is a denial I'm working on from 09 i have a # of them that are the same pt is in the Emergency dept is seen by the surgeon and he admits pt. and does surgery. i thought that the ED was out pt. but the denial was for code 99245 out pt. consult. would 99223-57 work for this situation?

  4. #4
    Location
    North Carolina
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    3,126
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    I'm trying to follow your scenario...

    If your surgeon was called to see the patient as a consult and no admission took place, I would bill the consult service (assuming the consultation requirements are met)

    If your surgeon actually admitted the patient, I would bill the appropriate admission code with modifier 57 if there was also a decision for surgery.

    Does this help?

  5. #5
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    I would agree with Rebecca...if the surgeon is the provider who actually admits the patient, then the ED service (consult) could be bundled into the initial admission code and should be reported with modifier -57. What is the actual denial you are receiving?

    Jen

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