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Hospital E/M

  1. Default Hospital E/M
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    I am trying to figure out something, I have been told diffrent things. I am new at coding for a cardio physician whom is part of a group of cardios. He was consulted on a patient in a outpatient hospital setting. Can he charge for an OP/NP E/M code or are they an est pt?

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    Quote Originally Posted by mlburnett View Post
    I am trying to figure out something, I have been told diffrent things. I am new at coding for a cardio physician whom is part of a group of cardios. He was consulted on a patient in a outpatient hospital setting. Can he charge for an OP/NP E/M code or are they an est pt?
    Was this truly a "consultation" as defined by CPT? If so, you would need to code this as a consultaion and as such, it doesn't matter whether the patient was new or established. Since this was an outpatient, you would use the codes from the 99241-99245 range.

    However, not all payers will pay for consultations, Medicare chief among them. If this is the case for this patient, was the patient ever seen by one of your cardiologists within the last three years? If so, because the patient was treated a physician of the same speciality within the same group in those three years, you would need to use the established office/outpatient visit code, 99212-99215. If the patient does not fit this definition of an established patient, then you would use 99201-99205 as appropriate for a new patient office/outpatient visit.

    Hopefully this helps you. Keep the questions coming if you need more help.

    Lance Smith, MPA, COC, CPMA, CEMC, RHIT, CCS-P, CHC, CHPC

    Director, Health Information Management
    HealthAlliance of the Hudson Valley
    Kingston, NY


    2016 Secretary
    Ellenville, NY Local Chapter

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