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Ed consults by specialist

  1. #1
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    Default Ed consults by specialist
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    I have a fast question. We are a cardiology group and a physicain wants to know if he is called into the ED to do a cardio consult, would we bill out the 99281-99285 or outpatient codes? I know I saw on a post that is it was a medicare pt, you could. If regular commercial insurance, you have to bill the outpatient codes.

    Thanks for your input!!

    Kris

  2. Default
    .......I know I saw on a post that if it was a medicare pt, you could (code a consult). If regular commercial insurance, you have to bill the outpatient codes.

    You have it backwards.

    It is Medicare that does not recognize 99241-99255 consult codes. There are also non-medicare payers that have followed this lead. Other non-medicare payers will recognize and pay the consult codes. You will have to verify how you payers are processing

  3. #3
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    Quote Originally Posted by klcf View Post
    I have a fast question. We are a cardiology group and a physicain wants to know if he is called into the ED to do a cardio consult, would we bill out the 99281-99285 or outpatient codes? I know I saw on a post that is it was a medicare pt, you could. If regular commercial insurance, you have to bill the outpatient codes.

    Thanks for your input!!

    Kris
    If your Cardiologist is called to the ER for a "consult" and this "consult" does not result in an admission, you would report an emgergency department code since Medicare no longers recognizes consultation codes.

    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 an emergency department visit code. If the patient is admitted to the hospital by the second physician performing the evaluation, he or she should bill an initial hospital care code and not an emergency department visit code.

    Page 55 or section 30.6.11 F

    http://www.cms.gov/manuals/downloads/clm104c12.pdf

    As for other commerical carries, unless they are following Medicare's consultation policy, you could report the consultation codes. IF they are following Medicare's consultation policy, reporting an ER code versus outpatient codes could also become carrier discretion.

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