# ER consult ?



## cpccoder2008 (Feb 20, 2009)

Per CPT guidelines " When a patient is admit to the hospital as an inpatient in the course of an encounter in another site of service (ER) all e/m services provided by that physician is conjunction with that admission are considered part of the initial hospital care when performed on the same date as the admission. "

 Question ?
Patient presents to the ER for abd pain. ER doctor calls surgery for consult. CT shows cholecystitis.Surgery see's pt in ER. Surgery decides to admit patient and bring to OR next day. 

My doc what's to bill inpatient cosult instead of admit. I would say i have to bill either admit or office consult since the consult took place in the ER. Would this be correct ?


----------



## kevbshields (Feb 20, 2009)

If the surgeons make a decision to admit, then they are assuming care of the patient--hence, this is no longer a consultation.  If a provider elects to admit, that professional service takes precedence over any "consultative" services furnished during the encounter. 

If the consult occurred before the patient was admitted, the POS would be OP anyhow.

Hope this helps.


----------



## cpccoder2008 (Feb 25, 2009)

kevbshields said:


> If the surgeons make a decision to admit, then they are assuming care of the patient--hence, this is no longer a consultation.  If a provider elects to admit, that professional service takes precedence over any "consultative" services furnished during the encounter.
> 
> If the consult occurred before the patient was admitted, the POS would be OP anyhow.
> 
> Hope this helps.



So would it be accurate to code just the admit with -57 ?


----------



## Lisa Bledsoe (Feb 25, 2009)

I agree with Kevin...and yes mod -57 would be applicable.


----------



## FTessaBartels (Mar 5, 2009)

*Admitted the next day?*

Was the patient admitted immediately or did the patient leave the ER to return the next day for admission & surgery?

If admitted the same day, directly from ER ... then code the admission w/ -57 modifier. (CPT clearly tells us to include all the work done in the admission code.)

If ER consult performed and patient sent home to return next day for surgery ... then code the appropriate OP consult w/ -57 modifier.  Do NOT code the admission H&P which will still need to be performed on day of surgery. 

And, Kevin, in principle I disagree with your statement "If the surgeons make a decision to admit, then they are assuming care of the patient--hence, this is no longer a consultation."  Whether it is a consult is dependent on the intent of the requesting physician, not the decision of the consultant as a result of his/her evaluation & examination of the patient. It was still a consultation ... but we roll in into the admission per CPT guidelines. (Semantics, I know ...)

F Tessa Bartels, CPC, CEMC


----------

