Results 1 to 7 of 7

ER Consult - Often times our Interal Medicine Physicians

  1. Default ER Consult - Often times our Interal Medicine Physicians
    Exam Training Packages
    Often times our Interal Medicine Physicians are called to the ER by the ER doc
    for a patient they think needs admitted. Once our doctors sees the patient he decides otherwise and sends the pt home. Our doc's want to code this as
    a consult but I have been told by Medicare that it cannot be because the pt will not be returning to the ER doc for further treatment.

    Any and all info will be greatly appreciated

    Thanks

  2. #2
    Default
    I would suggest to your docs the use of ER Dept visit E/M codes 99281- 99285. If you use these, make sure you get the place of service as the ER. Hope this helps!

  3. Default ER consult
    If the consult request, opinion, and reply were properly documented, you would code it as an outpatient consult visit at the appropriate level (please see Office or Other Outpatient Consultations in your CPT). You are lucky; many IM teams fail to notify their coders that they've been called in for a consult because an admit was not done and revenue gets lost. I'm not sure why Medicare is not paying your claims.

  4. Default
    I have always used outpatient consult codes for ER and get paid, but you do need to put the ER doc as referring phys.

  5. #5
    Default
    Quote Originally Posted by lljenkins View Post
    Often times our Interal Medicine Physicians are called to the ER by the ER doc
    for a patient they think needs admitted. Once our doctors sees the patient he decides otherwise and sends the pt home. Our doc's want to code this as
    a consult but I have been told by Medicare that it cannot be because the pt will not be returning to the ER doc for further treatment.

    Any and all info will be greatly appreciated

    Thanks

    I don't think a consult should be billed either nor a ER visit. The ER doc billed for the ER visit, and only one physician can bill these codes per day, which is normally the ER doc because they are the first to get to the patient. If 2 ER visits are billed same day, same dx, different docs, usually the doc who gets the claim in first gets paid. I don't think the consult should either because the referring physician is usually the one who makes the ultimate call in the care of that patient. ER "consults" are much rather "referrals" - the ER doc is passing the buck. I get this scenario a lot when the ER calls, say the general surgery service - this isn't "truly" a consultation - it's a referral to the "service" - the ER doc isn't asking the professional/advice or opinion, they usually already know and they will no longer be involved in the care of the patient.

    In your case, you should bill established outpatient codes, 99211-99215 with place of service ER or Outpatient. I understand the ER doc may be calling and asking for your doc's advice but there's more to a consultation that just that.

    I use this table a lot:

    Consult:
    o Suspected problem or know problem
    o Undetermined course of tx
    o Written request for opinion/advice from referring provider, including the reason for consultation
    o Written opinion returned to referring (telephone calls are sufficient, but need to be documented)
    o Referring physician will decide who will manage care
    o Patient advised to follow up with referring physician
    o Final diagnosis is probably unknown
    o Recommended Documentation: Please examine patient and provide me with your opinion

    Referral:
    o Known problem
    o Prescribed and known course of treatment
    o Transfer of partial or total patient care for the specific problem
    o Appointment made by patient
    o No further communication required with referring provider (or limited contact)
    o Physician is managing the known problem from the beginning
    o Patient advised to return for continuation of treatment
    o Final diagnosis typically known at time of referral
    o No written letter or report required
    o Recommended Documentation: Patient referred to your office for evaluation and treatment



    Just my 2 cents
    Last edited by ARCPC9491; 09-05-2008 at 09:54 AM.

  6. #6
    Location
    Greeley, Colorado
    Posts
    2,045
    Default Agree
    I entirely agree with ARCPC9491!!
    Lisa Bledsoe, CPC, CPMA

  7. #7
    Default
    wow.....MC says no to consult? i see that as consult. ER Doc "thought" patient might need admitted and requested your guys opinion and called him in!! Your guy gives his opinon and sends pt home. i see this as consult

Similar Threads

  1. ER Consult vs Inpatient Consult
    By lcouto in forum Emergency Department
    Replies: 1
    Last Post: 10-22-2015, 11:08 AM
  2. E/M OBV Consult converted to Inpt Consult
    By AmandaHartman in forum E/M
    Replies: 1
    Last Post: 06-13-2014, 11:36 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, 07:32 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?

Login

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.