Gastroenterology Coding Alert

Inpatient or outpatient will affect your choice

Don't be left in a tizzy when your gastroenterologist sees his patient in the emergency department (ED). If you can answer three questions, you-ll pick the right code every time.

Wade Through the Scenarios
 
There are so many variables when your gastroenterologist sees one of his patients in the ED that coding for it can be a nightmare. If the ED doctor is looking for your gastroenterologist's opinion, you-d use one set of codes. You also have to determine if the patient was admitted or released within 24 hours. Get to the bottom of these types of situations with a little help from our experts.

Question #1: Was the Patient Admitted?

Finding out if the patient was admitted to the hospital is a major step when solving ED coding challenges.
 
Scenario 1: If the ED doctor requests that your gastroenterologist provide an evaluation and opinion about how to manage the case and the gastroenterologist prepares a report directed back to the ED or admitting physician, you can consider the gastroenterologist's service a consultation, says Glenn Littenberg, MD, FACP, in Pasadena, Calif.

For this case, you would generally use a level-three consult code or higher, such as 99253 (Initial inpatient consultation for a new or established patient -), says Eunice Strange, billing specialist for Cary Gastroenterology Associates in Cary, N.C.
 
Scenario 2: If the ED physician asks the gastroenterologist to admit a patient for gastrointestinal bleeding and the gastroenterologist serves as the primary admitting physician, you should consider the service an inpatient admit, Littenberg says.

You would probably use the high-complexity admission code 99223 (Initial hospital care, per day, for the evaluation and management of a patient -) in this case, Strange says. Exception: If the patient is in the hospital for fewer than 24 hours, you might use one from the observation or inpatient care services codes (99234-99236), depending on the evaluation level that the physician provides, Strange adds. The level code you use depends on the evaluation level from your gastroenterologist, she says.

Question #2: Is It an Established Visit in the ED?

If the gastroenterologist asks an existing patient to go to the ED and then goes there to evaluate the patient, this might be an established patient visit in the ED location, Littenberg says. Assuming the patient goes home from the ED, you would use the established patient E/M codes (99212-99215), but the place of service would be the hospital emergency department instead of your office, Strange says.

As before, if your gastroenterologist admits the existing patient to the hospital, you should use the standard hospital admission codes (99221-99223) or one from the observation or inpatient care services codes (99234-99236) depending on the evaluation level that your physician provides.

Question 3: Is It an ED Services Code?

You can use an ED service code for either scenario listed above as an alternative to a consultation or an established visit code, Littenberg says. There are nuances of content of the visit (required elements), and depending on the payer, one service may pay more generously, he adds. Coding options are somewhat flexible unless the gastroenterologist admits the patient.

Example: A patient with acute gastroenteritis comes to the ED. The ED physician contacts the gastroenterologist to assess and treat the patient. The gastroenterologist evaluates the patient in the ED and then decides on a treatment method and arranges for prescriptions before ordering the patient's discharge.

You can code this service using one of the ED codes (99281-99285); as an outpatient service with 99201-99205 if this is a new patient; as an outpatient service with 99212-99215 if this is an established patient; or as an outpatient consultation, at the appropriate level (99241-99245). The place of service with each code should be the ED. To use 99241-99245, the gastroenterologist's notes should indicate that the ED physician consulted with him to evaluate patient.