How to Code that Consult in the ER

by Steve Adams, CPC, CPC-H, CPC-I

 

When seeing a patient in the ER you have a few options to consider before billing your face-to-face service. This will be based on the reason for the visit, the results of the visit, and on the patient’s insurance.

Example 1:

If you meet your established patient in the ER as a courtesy to the patient and not because it is a true emergency, you should bill an outpatient code (99201-99215) with the place of service for the emergency room (23). (regardless of insurance)

Example 2:

If you see a true emergency patient in the ER and later admit the patient to your service from the ER and you document an admitting H&P, you should bill the service as an initial hospital visit 99221-99223. (regardless of insurance)

Example 3:

If you are asked to see the patient in the ER and the patient’s insurance company accepts consultation codes and you do not admit the patient to your service, you can bill the service as an outpatient consultation visit. Outpatient consultation codes are 99241-99245.(this is normally for commercial carriers)  

Example 4:

If you see the patient in the ER at the request of another provider and the patient’s insurance company does not accept the outpatient consultation codes and you do not admit the patient to your service, you can bill the visit as a 99281-99285. (this is normally Medicare and Medicaid)

Example 5:

If you see the patient in the ER and admit them to the hospitalists’ service, you would not bill an initial hospital visit 99221-99223, because you are not the admitting provider of record. (You therefore will have to refer back to example 3 or 4).

Remember this too:

If you see the patient in the ER as a consultation service and decide the patient needs surgery and the patient is sent to the operating room don’t forget to append your modifier 25 if the global period for the surgery is 0-10 days – or use the modifier 57 if the surgery on the same day or next day is major surgery and has a global period of 90 days. The modifier 25 and/or 57 would be appended to the Evaluation and Management Codes described above depending upon the service you provided.

  

Steve Adams, CPC, PCS is a Senior Consultant for InGauge Healthcare Solutions, Inc., an InHealth company.   Contact him for consulting and educational services at steve.adams@ingaugehsi.com.  Efficiency in Practice is the free eNewsletter for medical practice managers who want to save time, money and reduce risk.  For more information and to access your FREE report, Patient Collections: It’s Make or Break for Many Practices, visit www.efficiencyinpractice.com 

This article can be reprinted freely online, as long as the entire article and this resource box are included.

 



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