EM Coding Alert

You Be the Coder:

Ask Payer For Preferred Consult Code

Question: When I use 99283 and 99284 I constantly get denied by my payer. My doctors go in to see a patient and consult with them while they are in the ER. Then the patient is discharged and goes home. Should I be using 99213 with the appropriate place of service 23 instead?

New York Subscriber 

Answer: If the physician tells the patient to go to the emergency room, you should report a service code from the 99211-99215 (Office or other outpatient visit for the evaluation and management of an established patient, …) series. If the physician was asked to see the patient in consultation, the 99241-99245 (Office consultation for a new or established patient, …) series is what you should use if your payer allows you to use consultation codes. Medicare would ask you to submit 99201-99215 (Office or other outpatient visit for the evaluation and management , …). 
 
In the non-Medicare case, you would code 99241-99245 for the consultant services. The level of consultation is based on the documentation in the medical record and the documented problem(s) establishes medical necessity for the consultation.
 
Payer rules will often dictate the code series used. Some may prefer to use 99281-99285 (Emergency department visit…) for a visit and the consultation codes for a consult.