Gastroenterology Coding Alert

Question: One of our patients came through ER at 1 p.m. in the afternoon and was admitted on the same day at 4.30 p.m. Our gastroenterologist saw the patient at 10.30 p.m. the same night. I used 99254 with place of service (POS) as inpatient. But my colleague is of the opinion that it should be billed using 99285 as the patient came through the emergency room although our gastroenterologist did not see the patient in the ER. Tell me who is correct.

Maryland Subscriber

Answer: If a patient is admitted into the hospital after an outpatient consultation (such as office, or emergency department) but the patient is not seen on the unit on the same day of admission, you have to report the relevant outpatient consultation codes (99241- 99245, Office consultation for a new or established patient, which requires these 3 key components...). However if the patient is seen on the unit on the same day of admission after the outpatient consult in the office or the emergency department, you will have to use the relevant inpatient consultation codes (99251 -- 99255, Inpatient consultation for a new or established patient, which requires these 3 key components...) for patients with commercial payers or with a relevant initial inpatient admission service code (99221 -- 99223, Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components...) for patients with Medicare coverage.

As your gastroenterologist saw the patient on the same day that the patient presented in the emergency department, you are right in using 99254 (Inpatient consultation for a new or established patient, which requires these 3 key components...Physicians typically spend 80 minutes at the bedside and on the patient's hospital floor or unit) with place of service as 21 (Inpatient hospital) instead of 99285 (Emergency department visit for the evaluation and management of a patient...).

In some cases a patient will be seen initially in the office but then is sent to the hospital for emergency evaluation and admission. Only one E/M service can be billed for a date of service. The work performed in the office may be combined with work performed later on the same day in the hospital to arrive at the appropriate service level.