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consultation/E/M Help :)

  1. #1
    Unhappy consultation/E/M Help :)
    Medical Coding Books
    I have been trying to figure out my surgeons consultation codes. His previous coder was still using 99241-99245 and 99251-99255 and we do Medicare and Wellmark- so now I'm trying to figure out how to bill his stuff. Here's all of my questions. If anyone has any advice on how to not over think these, that would be greatly appreciated.

    -If he does a consultation in the ER, then I can bill 99281-99285- correct?
    -If he says the patient is new or established and the admit date is the same as his consultation date, then do I use initial hospital care- 99221-99223?
    -If its a day after the admit date and he's seeing the patient, then is that the subsequent codes- 99231-99233?
    -If he says he's keeping the patient overnight for observation, then do I use an oberservation code-99234-99236 or will that be billed out with the inpatient stuff?
    -When do I bill normal 99201-99215 if the admit dates are the same as the consultants or do I consider those just regular outpatient visits???

    Any help?


    Brooke Bierman, CPC, CPB
    Coding & Billing Manager
    2014 President AAPC Des Moines Chapter

  2. #2
    Location
    Salt Lake City
    Posts
    841
    Default
    Well if your provider is that admitting physician he can bill 99221-223 with an AI modifier, then for the subsequent days he can bill 99231-99233. If he is not the admitting doc and does a consult he can still bill the 99221-99223 codes or the 99231-99233 depending on the documentation. For outpatient consults you would use 99201-99205.
    Jenifer McPolin CPC, CPMA, RCC

  3. #3
    Location
    Baton Rouge
    Posts
    1,241
    Default
    Quote Originally Posted by babierman View Post
    I have been trying to figure out my surgeons consultation codes. His previous coder was still using 99241-99245 and 99251-99255 and we do Medicare and Wellmark- so now I'm trying to figure out how to bill his stuff. Here's all of my questions. If anyone has any advice on how to not over think these, that would be greatly appreciated.

    -If he does a consultation in the ER, then I can bill 99281-99285- correct?
    We use outpatient new patient codes 99201-99205 for initial visits in the ER.
    -If he says the patient is new or established and the admit date is the same as his consultation date, then do I use initial hospital care- 99221-99223?
    Is your physician the admitting doc? If yes, then use the 99221-99223 along with modifier AI. If he is not the admitting doc, he will still use 99221-99223 but without the modifier; it doesn't matter if his consult is the same day as the admit.
    -If its a day after the admit date and he's seeing the patient, then is that the subsequent codes- 99231-99233?
    This is correct, if this is his followup visit. If it his inital visit for this encounter, he can use 99221-99223, regardless of new/est. or of whether or not its the same day as the admission.
    -If he says he's keeping the patient overnight for observation, then do I use an oberservation code-99234-99236 or will that be billed out with the inpatient stuff?
    This is correct if he is the physician that is placing the patient into observation. If a different physican put the pt in obs, but he is being consulted, he will use the appropriate outpatient codes 99201-99205 if new, or 99211-99215 if est.
    -When do I bill normal 99201-99215 if the admit dates are the same as the consultants or do I consider those just regular outpatient visits???

    Any help?
    Hope this helps; feel free to inbox me if you'd like further explanation!
    Meagan Strauss, CPC, CEMC
    Coding Coordinator
    The NeuroMedical Center
    Baton Rouge, LA

  4. #4
    Default
    Both of you ROCK! Thanks for the quick response too!

    I took all of my consultation visits out to try to match them up with the rules and I think I know why I'm confused. I can't tell if he's seeing the patient for the first time or if he's seen them before... there's no distinction. So initial versus subsequent is going to be difficult. He's the admitting physician on half but doesn't sound like he actually admits the patient...These below almost seem conflicting. I don't know. You helped a ton already!

    - example on one for a consult- it says, he's the admitting physician but his assessment states he will recheck her in the office in the am if she's not improving... so that one would be considered an established visit- only because I know I coded her surgery a week ago- which is global but now she's having pelvic pressure. Would this be a post-op one since it's related to her surgery she had?

    - another one - says a different doc for admitting physician but then my docs assessment says he will admit her for close observation and defer exam- is she gets worse, he'll take her in for surgery... I can't tell if she's new or established or um, yea

    - here's an ER ex- different admitting physician- he can't control the bleeding so he calls in my surgeon who does the consultant and then takes her away for surgery. I know I need the 57 modifier but other than that, I can't tell if she's new or established.

    what does inpatient daily care mean when he says he wants that coded along with a level three consultant?

    Any advice on how to make this easier with my physician? I only get what he faxes to me. I'm restricted to just the consults and general surgery stuff is all Makes things difficult as I am finding out.


    Brooke Bierman, CPC, CPB
    Coding & Billing Manager
    2014 President AAPC Des Moines Chapter

  5. #5
    Location
    New Windsor, New York
    Posts
    1,185
    Default ED Consultation
    If the consultation took place in the Emergency Department, a code from 99281-99285 should be used, as this is stated in MLN Matters #6740. This would make sense - even though the doctor may know the patient from office visits, each ED visit is treated as a new case. This is the criteria for ED docs and it makes sense to apply the same to consulting physicians as well. So, for your ED example, use the correct 9928x code with modifier 57.

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

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

  6. #6
    Default
    Ok, so I can use 99281-99285 for his consults in the ED, so those I coded correctly to start with? Some of the demos my physician sends over might say 'new patient consult level 4' or 'inpatient consult with daily hospital care level 3' and some other stuff...

    Sorry to be a pain, just trying to get these done correctly


    Brooke Bierman, CPC, CPB
    Coding & Billing Manager
    2014 President AAPC Des Moines Chapter

  7. #7
    Location
    New Windsor, New York
    Posts
    1,185
    Default
    Quote Originally Posted by babierman View Post
    Ok, so I can use 99281-99285 for his consults in the ED, so those I coded correctly to start with? Some of the demos my physician sends over might say 'new patient consult level 4' or 'inpatient consult with daily hospital care level 3' and some other stuff...

    Sorry to be a pain, just trying to get these done correctly
    Yes, I would concluded that you had those right from the get-go. And that MLM article is the "proof" you can show if you are challenged.

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

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

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