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Orthopedic Coding Alert

READER QUESTIONS:

When ED Refers Patient, Don't Bill Consult

Question: When an emergency department physician tells a patient to follow up with our practice (and doesn't name any of our surgeons in particular), can we report a consult code? The ED physicians don't ask our surgeons to report an opinion back to them, but our surgeons firmly believe that we should report these visits using the consult codes. Is that accurate?


North Dakota Subscriber


Answer: You should not report a consult code (99241-99245) in these situations. Once the patient leaves the ED, he is no longer under the ED physician's care. Therefore, the ED physician is transferring the patient's care to the orthopedic surgeon--he's not asking for your surgeon's opinion.

In addition, your orthopedic surgeon most likely does not communicate his recommendations for treatment back to the ED physician. However, if your orthopedic surgeon tries to use the argument that he sent a report back to the ED physician and is therefore justified in billing a consult, you should advise him that a report alone does not make a consult.

Instead, you should only report the consult codes when the requesting physician (in this case, an ED physician) requests your surgeon's opinion. If he merely transfers care to your surgeon, you should not bill a consult, whether or not your surgeon writes a report.


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