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Emergency Department consults with Medicare as prime

  1. #11
    Location
    North Carolina
    Posts
    3,126
    Default
    Exam Training Packages
    Quote Originally Posted by Katkia222 View Post
    No, in this case another physician admits the patient....after our specialist performed an ER consult. For some reason a two of our carriers are denying our outpatient ER consultations when the patient later becomes inpatient.
    And you billed from 99281-99285? and they denied?

  2. #12
    Default
    No, we billed 99244 with the place of service as the ER. That is how we bill all our ER consults, but every so often we get a denial, and it usually ends up being a patient who was seen in the ER and then later admitted, by someone else.

  3. Question POS 23 "Consult"
    How about a consulting physician (Hospitalist) called to the Emergency Department by the E/R doc at 11 pm and the consulting physician sees the patient in the Emergency Department and decides to admit the patient, but the patient is not actually admitted (because perhaps beds were not available before 12AM) as an inpatient until the next calender day. Under the new Medicare guidelines would the consulting/admitting physician bill a code from the 99211-99205 or 99281-99285 series for the outpatient date and then a follow-up 99231-99233 code when the hospitalist rounds the next calender day? Patient was not put in Observation status at any time either, just wasn't admitted until the next calender date.

  4. #14
    Location
    North Carolina
    Posts
    3,126
    Default
    Quote Originally Posted by Katkia222 View Post
    No, we billed 99244 with the place of service as the ER. That is how we bill all our ER consults, but every so often we get a denial, and it usually ends up being a patient who was seen in the ER and then later admitted, by someone else.

    99244 for 2009, Medicare patients, would be appropriate (assuming consultation requirements are met)...From 1-1-10, I would bill from 99281-99285 if your specialist has been asked to see a patient in the ER that does not result in an admission. (again...we're speaking about Medicare and those carriers that follow Medicare's guidelines)

  5. #15
    Default ER Codes
    Upon listing to NGS free teleconference yesterday on the subject, and the one they had last week, it is my understanding that if a consult is performed in the Emergency Room you use the ED codes to report your consult, however, if your MD later that day admits the patient, you can only bill for the admit and not the consultation. There is another upcoming free teleconference dealing with this next week:
    Consultation Code Teleconference
    Wednesday, January 20, 2010
    11:00 a.m. – 1:00 p.m. ET
    Dial In Number: 866 837-0303
    Conference ID #: 49139695
    Heather Winters, CPC, CFPC

  6. #16
    Default ER Consults
    Maybe I am confused, and I don't mean to confuse anyone else, but my question is if the ER Dr calls a surgeon in to the ED for a consultation on a patient, renders his/her opinion but does not admit the patient, we should bill 99281-99285 for the surgeon, correct?

    Then does the ER Dr get paid for his services? In our ED the ER Dr usually does a complete hx, exam, and runs a multitude of tests, and then calls in the surgeon.

    Would we use the 99281-85 for both physicians?

    Thank you,
    Debbie

  7. #17
    Default Emergency Room Care
    It is my understanding that the ER doctor gets paid, and Surgeon gets paid. According to NGS you bill based on where the visit occurred and the complexity of the visit performed. They did not say anything about a modifier being needed for both clinicians to get paid. Again, National Government Services has a free teleconference next week that may be good to listen to. They also have an extensive question and answer period at the end of the presentation, however, I'd press *1 as early as possible if you have a question because they do not get to everyone during their QA sessions.
    Heather Winters, CPC, CFPC

  8. #18
    Location
    North Carolina
    Posts
    3,126
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    Quote Originally Posted by debwobig View Post
    Maybe I am confused, and I don't mean to confuse anyone else, but my question is if the ER Dr calls a surgeon in to the ED for a consultation on a patient, renders his/her opinion but does not admit the patient, we should bill 99281-99285 for the surgeon, correct?

    Then does the ER Dr get paid for his services? In our ED the ER Dr usually does a complete hx, exam, and runs a multitude of tests, and then calls in the surgeon.

    Would we use the 99281-85 for both physicians?

    Thank you,
    Debbie
    According to CR 6740, yes. I, for one, am keeping a close eye on this code range. I'm going to monitor Medicare's EOB's for any "issues"...

  9. #19
    Lightbulb Medicare/consultation coding
    Can anyone tell me what codes we are suppose to use if the documentation for a inpt consult does not meet the 99221-99223 key components? I thought I saw somewhere to use the 99231 & 99232 codes. Can anyone confirm that? I can't seem to find any direction from CMS as to what codes they want used. Thanks!

  10. #20
    Location
    Milwaukee WI
    Posts
    4,466
    Default What if you don't meet 99221
    This may depend on your carrier. WPS has instructed us to use 99499 Unlisted E/M.

    F Tessa Bartels, CPC, CEMC

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