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Consult in the ER

  1. #1
    Orange County
    Default Consult in the ER
    Medical Coding Books
    My doctor was asked to consult on a patient in the ER.. He admitted the patient to the hospital. Do I use an ER consult or In patient admit?

    We are having a conflict in our office as to what code to use. Anyone?

  2. #2
    Louisville, KY
    E/M are selected based on the the POS in which the patient is serviced and the patient's status at the time of the service. See CPT Guidelines for more information.

  3. #3
    Hi, this is what I found in the Medicare Claims Processing Manual, section 30.6.11 F., :

    F. Emergency Department Physician Requests Another Physician to See the
    Patient in Emergency Department or Office/Outpatient Setting
    If the emergency department physician requests that another physician evaluate a given
    patient, the other physician should bill a consultation if the criteria for consultation are
    met. If the criteria for a consultation are not met and the patient is discharged from the
    Emergency Department or admitted to the hospital by another physician, the physician
    contacted by the Emergency Department physician should bill an emergency department
    visit. If the consulted physician admits the patient to the hospital and the criteria for a
    consultation are not met, he/she should bill an initial hospital care code.

    Hope this helps,

  4. Default
    I think the "if consult criteria are met" is the key here. Is the ER physician asking your doc for an opinon or is he transferring care?

    "A transfer of care occurs when a physician or qualified NPP requests that another physician or qualified NPP take over the responsibility for managing the patient's complete care for the condition and does not expect to continue treating or caring for the patient for that condition. "

    Is the ER doc expecting to continue treating the conditon?

    Medicare's E&M Help Center: Consult vs Transfer of Care document has good examples.

  5. #5
    Orange County
    The ER physician asked for the surgeon's opinion to determine the need for surgical intervention. My doctor admitted the patient to the hopsital after doing a comprehensive examination in the ER and determinining in the ER that the patient did indeed need surgery. It is my opinion that this is indeed a consultation since a request for an opinion was requested. I thought a transfer of care was when a physician accepts the care of a patient from another physician (i.e. tx from another hospital ) ...please correct me if I am wrong.

    Thank You

  6. #6
    Lewiston, Maine
    I would report it as a consult. The ER doc bills for the ER visit. They won't be happy with you taking their payment!
    Catherine Nolin, CCS, CPC, CGSC

  7. #7
    Hi - but it would be an outpatient consult, correct?


  8. Default
    If all the critea meets a consult, then outpatient consult. Documentation is in the instructions under Office or Other Outpatient Consultations of the CPT book.

    Office or Other Outpatient Consultations (99241-99245)
    New or Established Patient (99241-99245)
    The following codes are used to report consultations provided in the physician's office or in an outpatient or other ambulatory facility, including hospital observation services, home services, domiciliary, rest home, or emergency department (see the preceding consultation definition above). Follow-up visits in the consultant's office or other outpatient facility that are initiated by the physician consultant or patient are reported using the appropriate codes for established patients, office visits (99211-99215), domiciliary, rest home (99334-99337), or home (99347-99350). If an additional request for an opinion or advice regarding the same or a new problem is received from another physician or other appropriate source and documented in the medical record, the office consultation codes may be used again.

    Hope this helps.

    Quote Originally Posted by Carol Yarbrough View Post
    Hi - but it would be an outpatient consult, correct?


  9. #9
    Thumbs up Codegirl is correct!
    I just completed that same question at E/M university for free CEUs. If the consult treats a patient admitted in the ER: Bill outpatient consultation
    ( Quote from Dr. Jensen M.D.)

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