# Intraoperative consult



## Roni1962 (Nov 13, 2014)

Does anyone have any thoughts on how to code for an intraoperative consultation & Cysto performed at the same time?  Urologist called to OR for consult for possible ureteral injury and performed Cystourethroscopy, Retrograde pyelogram.  Ureteral injury suspected by GYN surgeon


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## nateich (Nov 13, 2014)

My understanding about intra op consults is, an EM cannot be billed as the elements of an EM are not met. Therefore, billing the procedure only.

Although, I would like to see other opinions. Because this is always a topic of discussion in our office.


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## Roni1962 (Nov 15, 2014)

Thanks for your response.  I just thought I was missing something. Surgeaons (urologist) are being "cheated" out of revenue, especially when a consultation is established, an opinion is beight sought at the request of another physician to either recommend care for a specific condition or problem.  Maybe AUA can get something going abouth this issue .


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## sscott@hogonc.com (Nov 4, 2020)

Is there any updated information regarding this?  If the urologist sees the patient the following day after the intraoperative consult/cysto, can you bill a new/initial hospital visit since he wasn’t able to bill the consult the day prior with the cysto due to the consult being intraoperative and the patient being under anesthesia?


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## csperoni (Nov 4, 2020)

1) I don't think the issue is that you cannot be paid for an E/M visit, but rather that the elements of E/M are either not performed or documented, therefore cannot be billed.  If your urologist created a note  documenting hx, exam & MDM, the E/M could be billed with -57 if he determined procedure was needed, or no modifier if only consult.
2) I personally have never seen a physician document an intraop consult this way so that it could be billed, despite guidance provided.
3) If the E/M day 1 is not billable, but you provide other services, then day 2 is either postop period (depending on services provided), or subsequent since you already provided services on day 1, therefore is not initial care.  The definition is "initial hospital *care*" not initial hospital *visit*. 
IF the carrier still accepts consult codes, AND you meet the official consult requirements (request, render, reply which is highly unlikely, but possible), you could bill IP consult codes.


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## sscott@hogonc.com (Nov 4, 2020)

Thank you!


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