EM Coding Alert

Question: Doctor A from our office was asked to provide an interoperative consultation by Doctor B. Doctor A didn’t scrub in for a surgical procedure but she did appropriately enter the operation suite to provide the requested consult during the surgery. Is this considered an E/M and if so, which E/M?

Minnesota Subscriber

Answer: Because this is an inpatient consultation by your physician, you would use the appropriate level from the 99251-99255 (Inpatient consultation for a new or established patient, …) range. The appropriate level depends on the level of the history, examination, medical decision making (MDM), and/or time she spent in the room during the operation. Often an exam and history are fairly limited for these types of consultations.

The documentation your doctor provides is important because if she doesn’t put a note in the patient’s file that she walked into the operating room, the consult won’t be billable.

Tip: When the provider requesting the consult shares a common medical record, a separate report sent to the requesting provider isn’t necessary. However, the note should indicate who requested the consultation and why. Report only one initial inpatient consult per inpatient stay.

You will have to code differently if your payer follows CMS which no longer recognizes consultation codes.

Alternative: If your payer doesn’t accept 99251-99255, you should use 99221-99223 (Initial hospital care, per day, for the evaluation and management of a patient, …) or 99231-99233 (Subsequent hospital care, per day, for the evaluation and management of a patient, …).