Forum - Questions & Answers

Dec 9th, 2014 - Sha12 62 

Hospital Consultation

Pt was in a auto accident & admitted at the hosp. The attending physician ask her PCP for a hosp consult regarding her medical management. Do I have to bill 99223-99238 for the visit? Do I have to do something to tell her insurance that this admission is related to auto? Do I have to bill auto or Pt's medical insurance? Help

Dec 9th, 2014 -

re: Hospital Consultation

If the attending physician ask her PCP for a hosp consult and he did not take over care or treatment regarding her injuries, you would use the inpatient consultation codes 99251-99255 and only one consultation should be reported by a consltant per admission. Subsequent services during the same admission are reported using the subsequent hospital codes 99231-99233. As for billing you should be using the patients PIP(Personal Injury Protection)from her auto coverage until she/he hs exhausted the amount of protection they have under their policy. This information should be given to you once the patient has contacted thier insurance and you should be given a claim number from the insurance co. if not you can bill the patient's health insurance, but once they find out it was an auto accident they will deny the claims and request their monies back or retract it. As far as notifying the insurance they will know as you need to bill the injuries, such as neck pain or back pain, etc, with the E code section of the ICD-9 book( Eternal Causes of Injuries and Poisioning) E810-E819 Motor Vechile Traffic accidents. This will alert the patient's health insurance that the injuries were caused due to a MVA accident. Hope this was helpful to you, if I can assist you in any other way please let me know:)

Jan 12th, 2015 - Sha12 62 

re: Hospital Consultation

Thanks for your feedback, I appreciate it so much. I have another question. Pt's PCP went to see her on the same day of admission. Do I have to bill a consult code along with the subsequent services or I only have to bill the subsequent codes?



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