Results 1 to 6 of 6

Consult in ER by Hospitalist

  1. #1
    Daytona Beach, FL
    Talking Consult in ER by Hospitalist
    Medical Coding Books
    Our hospitalist was called to the ER to consult on a pediatric patient with a sore throat. The hospitalist did the consult and recommended that the patient be given antibiotics and be sent home. The hospitalist billed 99242. Now BCBS is denying claim stating that the procedure is inconsistent with the place of service and suggested billing the correct POS. They are denying this saying the 99242 is not payable in the ER.

    Can someone offer what code we should be billing with? According to CPT this is the correct code for a consult in the ER, so I am not sure what they want. The ER doc billed the codes for the ER and since this is not a medicare patient, I know we can't bill that code too!

    If anyone has any ideas of what code we should be billing - or if we coded this right, I would appreciate your response!

    Jodi Dibble, CPC

  2. #2
    Daytona Beach, FL
    Anyone out there able to help with this???
    Jodi Dibble, CPC

  3. #3
    Seacoast-Dover NH
    Hi Jodi

    I have found if I code with POS 23 for the ED they usually will get paid. Some carriers want to see the place of service as outpatient POS 22. Hope this helps!

    Lori Bettencourt, CPC
    Hampton NH

  4. Default
    consult in ER by Hospitalist:
    Jodi, it really fits as you places as per the Coding manual. But do the careers view differently the ER service in Hospital setting than an ED in facility Service so much so to weigh on the POS rather than the type of service requested, as we all know that the consult for ED is to be placed from Office /outpatient consultation as per guidelines.
    Consult is a consult (as perthe definition in our manual) be it required of a Hospitalist or Specialist Consultant.
    Or, are the payers trying to remove or avoid the consulation E/M code in this scenario?
    May be they do not take the hospitalist consult as a "consult" ( if not a Ped hospitalist?)
    May be they just consider as the attending physician??!!
    By coding rule and in the coding world, it is not correct to turn the table to 23 instead of 22.
    But in realty, the ER of a hospital does not belong to the office visit or outpatient consultation. In that way, ER- E.D is the POS.
    I think you should get an explanation from them as to why should it be from ER E/M code as a deviation from the general norms of our coding guidelines?

  5. #5
    Default consult done in Er
    I assume that the provider saw the patient in the ER. Why couldn't you just use the E&M codes for the ER, especially if the POS is for he ER? Any physician can use the ER codes if the pt. was seen in the ER.

  6. Default
    I have noticed that some bc/bs claims are being subjected to the no consult code law
    used by Medicare. It might be that you need to use a new office visit code for the consultation. Also If you did bill the consult be sure that you used the correct pos ER and not as inpatient. You might just have to appeal and explain the rule to them as sometimes
    the insurance companies deny without really looking at the situation.

Similar Threads

  1. E/M OBV Consult converted to Inpt Consult
    By AmandaHartman in forum E/M
    Replies: 1
    Last Post: 06-13-2014, 10:36 AM
  2. Hospitalist and Rehab "hospitalist"
    By bertll in forum E/M
    Replies: 0
    Last Post: 04-22-2014, 11:37 AM
  3. Hospitalist consult in the ER
    By Gemini18 in forum Emergency Department
    Replies: 3
    Last Post: 06-03-2009, 01:37 PM
  4. Hospitalist consult
    By kstults in forum E/M
    Replies: 5
    Last Post: 04-06-2009, 01:02 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.