Gastroenterology Coding Alert

Question: A patient with acute gastroenteritis comes to the emergency department (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. Which codes would I report?

Georgia Subscriber

Answer: You can code this service using one of the ED codes in the range 99281-99285 (Emergency department visit for the evaluation and management of a patient). Alternatively you could use 99201-99205 (Office or other outpatient visit for the evaluation and management of a new patient ...) if this is a new patient or 99212-99215 (Office or other outpatient visit for the evaluation and management of an established patient ...) if this is an established patient. Remember to code the place of service (POS) as code 23 (Emergency room -- hospital).

Alternative: If the patient is not a Medicare beneficiary and the visit qualifies as an outpatient consultation, select the appropriate level code from the 99241- 99245 (Consultation for a new or established patient) range instead. To use 99241-99245, the gastroenterologist's notes should indicate that the ED physician requested a consultation with him to evaluate patient. You'll still usePOS code 23 since the service took place in the ED.