Results 1 to 2 of 2

E/M vs. Consult

  1. #1
    Default E/M vs. Consult
    Medical Coding Books
    Our office handles trauma patients (hand). We have a hospital trauma service that is denying our claims when we bill with a 99231 or 99232. They state that we should be billing with a 99251 or 99252. Our office disagrees as the dr is not just giving his opinion but taking over the care for the hand.

    We have all the documentation from the hospital service to back up our submission of the "corrected claim" with the 99251 or 99252. Should we continue to bill appropriately with the 99231 or 99232 and get the denial and then send the "corrected claim"? Or would it be appropriate to initially bill with the 99251 or 99252 as we have the documentation from the trauma service that they will only process payment under these codes?

    Thank you for your responses,

  2. #2
    Milwaukee WI
    Default Consult
    I believe the the proper code MAY be the consult ... even if your surgeon winds up taking over management of that issue.

    CPT 2008, Professional Edition, page 14 second paragraph of guidelines under Consultations:
    "A physician consultant may initiate diagnostic and/or therapeutic services at the same or subsequent visit."

    If you have access to the hospital chart, you might also find that the requesting physician has, indeed, placed an "order for consult by hand trauma surgeon."

    So if your hand surgeon is being asked by another physician to see the patient in consultation re hand injuries, and the hand surgeon is reporting back to the requesting physician (easy to do in an inpatient setting, as the patient's chart is accessible to both), then the first visit could be reported as a consult. Don't forget the -57 modifier if there is a decision for surgery as a result of the evaluation, and it is performed the same or next day.

    F Tessa Bartels, CPC, CPC-E/M

Similar Threads

  1. ER Consult vs Inpatient Consult
    By lcouto in forum Emergency Department
    Replies: 1
    Last Post: 10-22-2015, 10:08 AM
  2. E/M OBV Consult converted to Inpt Consult
    By AmandaHartman in forum E/M
    Replies: 1
    Last Post: 06-13-2014, 10:36 AM
  3. Billing OV Consult vs Hospital Consult
    By crowemd in forum Auditing General Discussion
    Replies: 1
    Last Post: 02-20-2012, 03:02 PM
  4. IP consult
    By cchilva in forum E/M
    Replies: 3
    Last Post: 06-16-2009, 06:32 AM
  5. Replies: 1
    Last Post: 01-24-2008, 02:16 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.