General Surgery Coding Alert

Question: If the emergency department (ED) physician requests a consultation from a surgeon for a patient who is in observation status for acute abdominal pain, would it be correct to bill an outpatient consultation code (99241-99245) on the same day? If yes, should I use any modifiers?

Missouri Subscriber

Answer: If the ED physician admits the patient to observation status as a result of a consultation with a surgeon, the surgeon could bill for the consultation. Even though the patient is in the observation unit of the hospital, the patient is still considered an outpatient. So the outpatient consultation codes (99241-99245) apply. You would not append any modifiers in this situation.

Keep in mind that the consulting surgeon should not submit observation care codes just because the patient is admitted to observation status. The reason for this is that only one physician can report observation care for a given patient on a particular day. In this case, the ED physician would report the appropriate observation care code (99218-99220).