# ER eval and consult



## broundy (Mar 24, 2010)

I hope someone can help me   If a patient goes to an office visit and then is sent to the ER from there and the ER doc calls in a internal medicine doctor that does an H&P with the understanding the patient will be admitted can you please answer these questions for me:

1.  Can I charge the ER visit, (I am pretty certain I can)
2.  Can I charge a consult for the internal medicine doc that did the H&P? (I would say it would be an outpatient consult as the patient was discharged)
3.  Can the office that sent the patient to the ER bill a visit? (I don't think so but I am not sure)

Thanks for any and all input. 

Bonnie


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## AuntJoyce (Mar 24, 2010)

Hi Bonnie,

I just know this will draw fire but I'm responding anyway...

In a nutshell...the way I see it is this:

The doc that saw the patient in the office, I am assuming will NOT be caring for this patient in the hospital.  If this indeed is the case, yes, he/she can bill for the office visit.  IF this doc were to be having this patient admitted to his/her service, then the office visit becomes the H&P - does not sound like the case from your scenario.

The E.R. doc who evaluated this patient and made the determination that the patient needs to be admitted, has appropriately requested the services of the an internal medicine doc to perform the H&P.  Actually, this internal medicine doc is not really a consultant because he/she is asked to admit the patient and assume care as their coordinating physician.  So, yes, the E.R. doc has done his/her job and has transferred care to the internist and may then bill for services rendered.

The internist has now assumed care of the patient - so, no consultation.  If the internist calls in another specialist for a consultation, that specialist can capture a consult - provided it is not Medicare (kill us now)...

Hope this is at least a little clearer than mud...

Have a good evening


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## broundy (Mar 24, 2010)

*Office visit and ER visit*

No thank you very much that makes sense to me.  I was a little bewildered why exactly an Internal Medicine doc was called in for the visit rather than a cardiologist since she had A-fib but with that being said I need to do more digging because would the scenario be different if the internal medicine doc was not called to admit but was called to evaluate the patient and he decided to admit?  At the end of the day, she was discharged without being admitted so does this mean anything?  Gosh how confusing


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## AuntJoyce (Mar 25, 2010)

*ER eval and consult...*

Good morning,

Had the Internist been called in to evaluate the patient (as in a consult) and found reason to admit, then the consult would essentially become the admit.  

Had the Internist been called in to evaluate the patient (as in a consult) and found no reason to admit, then it would, I believe, be acceptable for the Internist to bill a consult...

My rationale when the emergency room is involved is that the ER doc never really requests a consult because they will either treat and discharge the patient or, if the patient requires admission, request and turn over the care to the internist or cardiologist or whatever specialty they deem appropriate.  The defining moment or pivotal point, to me, is that the only one who could conceivably bill a consult would be, as above, the Internist deciding not to admit the patient.

Of course, if the Internist admits the patient and asks for a consult by a specialist who will not be treating the patient but only rendering an opinion, could then bill a consult.

Lest we not forget if the patient is Medicare, all bets are off and no chance of a consult even exists.

Hope this helps somewhat.

Thanks!

Joyce


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## broundy (Mar 27, 2010)

Thank you both very much I believe I have it now   In my particular case the internal doc did not admit, so he could charge the consult 

Thanks again!


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