Cardiology Coding Alert

Question: If the emergency department physician requests a consultation from a cardiologist on a cardiac patient who is in observation status, should we bill an outpatient consultation code (99241-99245) on the same day? If yes, should any modifiers be used?

Missouri Subscriber

Answer: The answer depends on who the admitting physician is. If the cardiologist admits the patient, then he or she would bill 99234-99236 (Observation or inpatient hospital care) based on documentation of the services performed. These codes cover both the admission and the discharge on the same date of service. The cardiologist wouldnt bill for consultation if he or she admitted the patient because you can bill only one E/M code per service per date of service. So the cardiologists consultation code would be included in the observation code. There would be no need to append any modifiers.

If another provider admits the patient to observation, then the cardiologist would bill using the outpatient consultation codes (99241-99245). The cardiologist wouldnt bill the discharge code because he or she did not admit the patient.