General Surgery Coding Alert

Question: The hospital asked my on-call surgeon to admit a patient. He spent one hour with the patient at the hospital but decided not to admit her. Normally, he sends patients from our office to the hospital, and I report an outpatient E/M. Should I use emergency department codes instead because the hospital contacted the surgeon?


Montana Subscriber

Answer: Yes, you could possibly report an ED service in this case, but first rule out the possibility that the emergency department visit qualified as a consult.

If your surgeon took over the patient's care from the ED physician, you can bill the appropriate ED services code (99281-99285) for any treatment your surgeon rendered to the patient. You need to account for only the services your surgeon provided, not the ED physician's treatment prior to the surgeon's arrival at the hospital.

Remember: You cannot use initial hospital care codes (99221-99223) or subsequent hospital care codes (99231-99233) because neither the surgeon nor the ED physician admitted the patient to the hospital.

Look for: If the ED physician called your surgeon into the hospital to provide a consultation and your surgeon did not take over the patient's care, you should report an outpatient consultation (99241-99245). You must have proper documentation that supports the consultation claim in the patient's chart.