General Surgery Coding Alert

Question: Our surgeon was recently on-call for the emergency department (ED). The ED physician asked for the surgeon's opinion on a patient's condition and asked the surgeon to recommend treatment options. How should we report this consult service in the ED?

Nevada Subscriber Answer: You should report consult codes 99241-99245 (Office consultation for a new or established patient) for true consultations that a surgeon provides in the ED. Many physicians and coders mistakenly believe that outpatient consults should be used for office visits only. In fact, such consultations may occur in any outpatient environment, including the ED.

The CPT introduction to "Office or Other Outpatient Consultations" states that you should use 99241-99245 "to report consultations provided in the physician's office or in an outpatient or other ambulatory facility, including hospital observation services, home services, domiciliary, rest home, custodial care or emergency department."

You should only report a consultation if the surgeon meets certain criteria. The real question is, did the ED  physician request your surgeon's opinion, or did the ED physician hand the patient over to the surgeon? For this to qualify as a consultation, the treating physician must specifically request the surgeon's opinion.