1. maarit v
   Posted 4 months ago #
   

   1)What if ER consult leads to observation admit and the consultant is listed as admitting doctor? Would it be ER visit code, out-pt consult code or just out-pt code?
   2)Also, can a new pt visit be coded as a consult, if the consultant decides to assume the care of the patient? Or does it matter?
   thank you for clarification.

2. SuperCoder
   Posted 4 months ago #
   

   1. A consultation in ER, if as per criteria of consultation, should be coded as consultation. But there are certain limiations to code this as consultation.
   Limitations:
   a) When "obseration status" is inititated in the course of an encounter in another site of service (eg, hospital emergency department, physician's office, nursing facility) all evaluation and management services provided by the supervising physician in conjunction with initiating "observation status" are considered part of the initial observation care when performed on the SAME DATE.
   b) Evaluation and management services on the same date provided in sites that are related to initiating "observation status" should NOT be reported separately.
   *
   *
   2. Medicare doesn't recongnize Consultation codes. If you are referring to that, then you are right that you should code Initial Hospital Care(99221-99223) for Inpatient consultations, and for follow-up consultations you have to bill Subsequent Hospital Care(99231-99233)
   But, if the insurance is not Medicare, then you must code Consultation (99251-99255)for Initial E/M if the said E/M goes by the definition of consultation. But, if the same physician assumes care of the patient means the follow-up consultations, then definitely the follow-up consultations are to be coded as Subsequent Hospital Care(99231-99233).

3. maarit v
   Posted 3 months ago #
   

   Thank you, Sanjit. Let me rephrase my question, because your answer did not apply:

   1) What if after doing an ER consult, the surgeon takes the PT to OR and does appendectomy. The PT remains in hospital for 2 days in out-pt status. The surgeon is listed as "admitting physician". Do I code the ER visit as 99283- 99285 or 99243- 99245 or 99203 - 99205?

   2) A pt is sent to a GI doctor by her PCP for a consultation over intestinal symptoms. The GI doctor examines the pt and decides to take her to OR in the near future for a colonoscopy + sends consult note to the PCP. Our auditor says I should not use a consult code for the initial visit, because the GI doctor decides to take over the pt care regarding GI symptoms. This example is really a referral of care.

4. SuperCoder
   Posted 3 months ago #
   

   1)
   a)
   If the physician provides "Consultation service" by three criteria of consultation, should be billed as "Outpatient Consultation"99241-99245. But if the same physician on same DOS, ADMITS the patient into OBSERVATION STATUS, and does the e/m as per Observation Coding criteria, then Consultation services should not be billed and only INITIAL OBSERVATION CARE should be billed.
   b)
   If the consultation service doesn't justify three criteria of consultation, then it should be billed as ED codes 99281-99285 if there is no Observation care on same DOS. But if the same physician on same DOS, ADMITS the patient into OBSERVATION STATUS, and does the e/m as per Observation Coding criteria, then ED codes should not be billed and only INITIAL OBSERVATION CARE should be billed.

   2) In the given link:
   http://www.supercoder.com/articles/articles-alerts/orc/consult-or-referral-stop-flipping-coins-with-expert-advice/
   an example is given below which is similar to your 2nd question. Plz refer to the examples:
   **
   **
   When another practitioner requests your orthopedic surgeon’s opinion about a patient’s condition, you should report a consult code.
   *
   Example: A patient presents to her primary-care physician (PCP) complaining of shoulder pain. The PCP cannot establish a diagnosis and asks an orthopedic surgeon to evaluate the patient and give his opinion regarding the patient’s condition and possible treatment methods. The orthopedic surgeon examines the patient, determines that she has a torn rotator cuff (840.4), and recommends arthroscopic repair (29827, Arthroscopy, shoulder, surgical; with rotator cuff repair). He sends the PCP a report with his diagnosis and his recommendation.
   The orthopedist’s service qualifies as an office consultation, and you should report the appropriate code from the 99241-99245 range.
   *
   Referrals: No request, no report. A referral, on the other hand, is the transfer of responsibility for a patient’s care from one physician to another, says Marvel Hammer, RN, CPC, CHCO, owner of MJH Consulting in Denver.
   *
   Example: A 23-year-old woman with severe knee pain reports to her internist. The internist orders an MRI, and the radiology report indicates that the patient has a torn medial meniscus (836.0). The internist refers the patient to the orthopedic surgeon for surgical repair. Because the internist does not ask the orthopedist to render an opinion on the patient’s condition, the orthopedic surgeon should code his service with a new patient office visit code (99201-99205).
   **
   **

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