ED Coding and Reimbursement Alert
Reader Question:
Check the Payer before Reporting a Consultation Code
Published on Wed Apr 16, 2014
Question: What is the right code to use in the following scenario?
Patient presents to the emergency room and a specialist consult is requested. The specialist (i.e. cardiologist, gynecologist) performs the consultation in the ED setting and the patient is not admitted.
Florida Subscriber
Answer: CPT® still contains consultation codes, so if that is the service performed by the specialist, they should use the appropriate outpatient consult code 99241-99245. Medicare does not recognize consultation codes, so if it is a Medicare patient, they would report using the ED E/M code.
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