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General Surgery Coding Alert

Reader Question:
Unravel Consult vs. Observation E/M

Question: Our surgeon was called for a consult while the patient was in observation status, and ended up doing an appendectomy. The patient was discharged in under 23 hours. Should we use the observation codes or the consult codes?North Carolina SubscriberAnswer: Assuming that the documentation for your surgeon supports a consultation and the payer is not Medicare (or another payer that no longer accepts consultation codes), codes 99241--99245 (Office consultation for a new or established patient ...) are appropriate for the consult. CPT instruction clarifies that these codes are appropriate for hospital observation.The physician who sent the patient to observation and requested the consult would use the observation codes (99218-99220).Medicare is different: If this is a Medicare patient, you shouldn't report a consultation code. Instead, you should choose one of the following codes for an E/M service that would qualify as a consult for a patient on observation status:99201-99205 -- Office [...]


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