Orthopedic Coding Alert

Question: Our orthopedist was recently on-call for the emergency department (ED). The ED physician asked for the orthopedist's opinion on a patient's condition and asked the orthopedist to recommend treatment options. We're considering reporting 99243. Is this the correct code for a consultation 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 an orthopedist 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 introduction to "Office or Other Outpatient Consultations" in CPT states that 99241-99245 "are used 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 orthopedist meets certain criteria. The real question is, did the emergency physician request your orthopedist's opinion, or did the ED physician hand the patient over to the orthopedist? To report any consultation, the treating physician must request your orthopedist's opinion.
 
If you haven't met the consultation criteria, you should instead report the appropriate-level ED code (99281-99285, Emergency department visit ...).   - You Be the Coder and Reader Questions were reviewed by Heidi Stout, CPC, CCS-P, coding and reimbursement manager at University Orthopaedic Associates in New Brunswick, N.J.