# Do you code as er or inpt



## maryann1224@bellsouth.net (Oct 14, 2015)

we need some clarification, our dr saw patient as a consult in the emergency room; however at that time patient had been admitted to 2nd floor, but the room was not ready yet, so the consult took place in the emergency room.  would this non Medicare patient be billed as ER Consult location 23 or Inpt Consult location 21.  

the face to face was done in the Emergency Room.

thank you so much for your input.


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## espressoguy (Oct 14, 2015)

I would code inpatient since the patient was admitted.


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## lcouto (Oct 15, 2015)

espressoguy said:


> I would code inpatient since the patient was admitted.



What about the Face to Face and place of location being done in the ER? That wouldn't be an ER consult?


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## kak6 (Oct 23, 2015)

Sounds like you are confusing yourself maybe. There are no "ER consult codes" you either use consultation codes as described below or Emergency room codes 99281-99285. Yes any provider can use ED codes, these codes are paid for professional services provided and can be used as long as documentation fits the service.

 Consultation codes are a big subject. Documentation must support a consultation service first of all. 
There must be documentation of request from your provider to the consultant requesting advice regarding evaluation and/or management of a "specific" problem due to the consultant's expertise in a specific medical area beyond the requesting provider's knowledge.
The request for a consultation including the name of the requestor and the need or reason for the consultation must be documented by the consultant in the patient's medical record.
After the consultation is provided, a written report of the consultant's finding, opinions, and recommendations is documented in the inpatient record for the requesting provider to use in the management of and/or decision making for the pt.
The intent of a consult is to return the patient to requesting provider for ongoing care of the problem.
During the service the consultant may: perform or order diagnostic tests, or initiate a treatment plan including performing emergent procedures.
If all of this has not taken place and documentation is not there then you will need to use whatever E&M code best fits the situation. If inpt status then use subsequent hospital visit codes. If in ED then use emergency room E&M (99281-99285)codes. If your documentation does not fit any of those you also have office visit codes to choose from. Documentation is key.
All of the E&M codes are paid out at a different rate, and consults are paid at a higher rate so be sure they meet or exceed requirements.
I hope this helps some, even if it causes you to go digging for more info.


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## CodingKing (Oct 23, 2015)

Patient status overrides location. My local hospital the big issue that came up. There has been significant space issues. Patients would be admitted to observation or inpatient status but their beds would be in the hallway of the ER for 24 to 48 hours because there was no room on the floor of the unit they have been admitted to. They were still receiving the services of the higher level of care so that's what would be billed.


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## mitchellde (Oct 24, 2015)

It comes down to this... Any bed in the facility can be an inpatient bed.  It is dependent on when the order was written.  If the physician order states admit, then from that point on they are inpatient.  In addition any bed can be an observation or outpatient bed.  If the provider writes an order to admit to outpatient observation, then even if the only bed available is in the ICU, it is still outpatient per physician order.


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## cherri.mills@mwhc.com (Jan 21, 2019)

*Written somewhere*

Is there a document stating this is the procedure? I have woman who present to the Emergency - then go have a baby, there is confusion as to bill for the ED visit as they present to the ED.  They go home or are admitted to have baby. Should we actually be billing inpt for the ED visit instead?


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