Medicare consult in ER

Surgeon does a consultation in the ER for a Medicare patient. The patient is later admitted that same day by ANOTHER DOCTOR. Does the surgeon bill an ER code with POS 23 or does he bill a 9922x with a 21 POS?

If you have a resource/link that would be WONDERFUL.

Mar 28th, 2012 - koatsj 160

re: Medicare consult in ER

If the patient was not admitted at the time of the consultation, you would bill the appropriate e/m code for an established patient (99211-99215) or for a new patient you would use (99201-99205). The AAPC website has alot of information regarding this topic.

Mar 28th, 2012 - LindaLou 81

re: Medicare consult in ER

CMS states we can use an ED code....is this not your understanding?

Mar 28th, 2012 - koatsj 160

re: Medicare consult in ER

Was an ER visit already billed out? Perhaps by the ED physician? If so, you can't bill out two ER visits for the same day.

Mar 28th, 2012 - LindaLou 81

re: Medicare consult in ER

You can actually. Medicare says it is ok since they took consults away.

https://www.cms.gov/MLNMattersArticles/downloads/MM6740.pdf

"If the ED physician requests that another physician evaluate a given patient, the other physician should bill an emergency department visit code. If the patient is admitted to the hospital by the second physician performing the evaluation, he or she should bill an initial hospital care code and not an emergency department visit code."

Mar 28th, 2012 - LindaLou 81

re: Medicare consult in ER

Im just wondering if that patient gets changed to an inpatient, will they pay my surgeons consult with the POS 23?

Mar 29th, 2012 - koatsj 160

re: Medicare consult in ER

Why wouldn't they? There would be a visit in the hospital system showing the patient was outpatient while your doctor evaluated the patient. I go through this alot with my surgeons.