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ER Consult by General Surgeon

  1. #1
    Default ER Consult by General Surgeon
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    Help, when I bill a 99282-99285 for my General Surgeon who consults in the ER I get denied against the ER doctor's billing. How do you bill for consulting when it is in the Emergency Room?

  2. #2
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    It depends on what kind of insurance the patient has? If it Medicare you cannot bill consult codes, you need to Hopital Inpatient codes 99221-99233. If its not Medicare its payor specific check w/your carriers/contracts....

  3. #3
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    Unless the patient has medicare or a medicare advantage plan you would bill an outpatient consult. If the patient has medicare you should check with your MAC regarding how they want these billed. NGS J13 says to bill with ER codes and they have been paying them.

  4. #4
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    Tacoma, WA
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    Quote Originally Posted by tkavanaugh@kvch.com View Post
    Help, when I bill a 99282-99285 for my General Surgeon who consults in the ER I get denied against the ER doctor's billing. How do you bill for consulting when it is in the Emergency Room?
    In reality, the CMS instructions for use the of the ER visit codes states:
    Pub-100 References - 100-4,12,30.6.11
    "E. Physician Billing for Emergency Department Services Provided to Patient by Both Patient's Personal Physician and Emergency Department Physician

    If a physician advises his/her own patient to go to an emergency department (ED) of a hospital for care and the physician subsequently is asked by the ED physician to come to the hospital to evaluate the patient and to advise the ED physician as to whether the patient should be admitted to the hospital or be sent home, the physicians should bill as follows:
    If the patient is admitted to the hospital by the patient's personal physician, then the patient's regular physician should bill only the appropriate level of the initial hospital care (codes 99221 - 99223) because all evaluation and management services provided by that physician in conjunction with that admission are considered part of the initial hospital care when performed on the same date as the admission. The ED physician who saw the patient in the emergency department should bill the appropriate level of the ED codes.
    If the ED physician, based on the advice of the patient's personal physician who came to the emergency department to see the patient, sends the patient home, then the ED physician should bill the appropriate level of emergency department service. The patient's personal physician should also bill the level of emergency department code that describes the service he or she provided in the emergency department. If the patient's personal physician does not come to the hospital to see the patient, but only advises the emergency department physician by telephone, then the patient's personal physician may not bill."


    "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"

    So according to CMS, if the patient is not admitted to the hospital but is seen by an ER provider and another provider, both providers should bill the appropriate ER visit code.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

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