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Eleen Posted Wed 06th of September, 2017 08:56:27 AM
If I patient is in the ER - And was seen by Emergency DR, who billed a 99285. Then same ER visit, patient is seen by Neurology physician - what would be billed by the Neurology physician? The ER dr already billed 99285. On the Neurologist's documentation it states it is an "initial consultation note". Any help is appreciated.
SuperCoder Answered Thu 07th of September, 2017 03:34:03 AM


As per the above scenario neurologist should bill for either 99251-99255/ 99221-99223/99231-99233 or 99241-99245/99201-99205/99211-99215 as per the admission status (Outpatient or inpatient) of patient at the time of consultation. Refer below mentioned scenarios for more clarification.

  • Consultations for Medicare patients are reported with new patient 99201–99205 or established patient 99211–99215 CPT codes.
  • For non-Medicare patients, office or other outpatient consultations are reported with codes 99241–99245.
  • if the consultation is done after the patient is admitted to the hospital, consultation services may be reported with the inpatient consultation codes 99251–99255.
  • Consultation codes are only appropriate if the patient is referred by another provider for consultation; otherwise, new or established patient codes are used.
  •  if the patient is admitted to the hospital by the consulting physician, he or she should bill an initial hospital care code (99221–99223) and not an ED visit code. Medicare requires that the admitting physician append modifier AI to the initial hospital visit code (9922X-AI).

Hope this helps!

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