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ER and OBS Consults

  1. #1
    Location
    Greenville, SC
    Posts
    51
    Default ER and OBS Consults
    Medical Coding Books
    CMS states to select the appropriate E/M code based on the location of where the service occurred, along with the elements of the documentation. That being said, for a consultation occurring in the ER, would this be an ER visit? For a consultation occurring while the patient is in observation status, would this be an Observation code?

  2. #2
    Default ER and Obs Consults
    If the emergency dept. physician requests that another physician evaluate a given patient, the consulting physician should bill an emergency department visit code (99281-99285). If the patient is admitted to the hospital by the consulting physician performing the evaluation, he or she should bill an initial hospital care code and not an emergency department visit code (99221-99223 and appending the AI modifier). As for your question regarding observation codes.. A patient is considered an outpatient until admission to a health care facility occurs. Therefore depending on the documentation i would code either 99221-99223 or new or established coded 99201-99205; 99212 to 99215 code set...

    hope this helps,
    Cheryl Anderson, LPN, CPC, CEMC,

  3. #3
    Location
    Daytona Beach, FL
    Posts
    752
    Default
    Quote Originally Posted by Andrschery View Post
    If the emergency dept. physician requests that another physician evaluate a given patient, the consulting physician should bill an emergency department visit code (99281-99285). If the patient is admitted to the hospital by the consulting physician performing the evaluation, he or she should bill an initial hospital care code and not an emergency department visit code (99221-99223 and appending the AI modifier). As for your question regarding observation codes.. A patient is considered an outpatient until admission to a health care facility occurs. Therefore depending on the documentation i would code either 99221-99223 or new or established coded 99201-99205; 99212 to 99215 code set...

    hope this helps,
    Cheryl Anderson, LPN, CPC, CEMC,
    I have a question about a portion of your response. If the doctor sees the patient in the ER for a consult and then the patient is admitted inpatient by another doctor, does the consulting doctor still bill with the ER code or do they now use the inpatient code? I have been billing as inpatient, but now I'm confused!

    Thanks,
    Jodi Dibble, CPC

  4. #4
    Location
    North Carolina
    Posts
    3,126
    Default
    If the consulting provider admits the patient, report an admit.

    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.

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

    30.6.11

    However...if your provider does not admit the patient, he would report an ER visit. The provider who admits the patient would, in turn, charge an admit.
    Last edited by RebeccaWoodward*; 12-08-2010 at 07:09 AM.

  5. #5
    Location
    Daytona Beach, FL
    Posts
    752
    Default
    Thanks Rebecca - I guess I have been using the wrong codes for when my docs see the patients in the ER prior to being admitted! .

    Thanks,
    Jodi Dibble, CPC

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