Pediatric Coding Alert

When a pediatrician sees a patient in the emergency department (ED), he or she may bill a consultation, 99241-99245. These codes pay well, but circumstances, outlined in the following examples, dictate whether such a code is appropriate.
 
Appropriate Circumstances  
The pediatrician can bill a consultation in the ED only  if the ED physician, or another appropriate source, requests the pediatrician's opinion on the care of the child. In this scenario, the child is not the consulting pediatrician's patient. Because the pediatrician could not bill for a consultation if the ED physician transferred care, the ED physician must handle the condition after the pediatrician provides the service.
 
For example, a 4-month-old has fever and irritability. The ED physician, uncomfortable handling the case due to the patient's age, requests a consultation from the pediatrician. The pediatrician evaluates and confirms a diagnosis of a febrile illness, provides an opinion to the ED physician and returns to his or her office. The ED physician counsels and discharges the patient for follow-up to the child's physician (perhaps a family practitioner). To bill the consultation, the pediatrician must send a written report to the ED physician.
 
The ED is an outpatient place of service, and therefore the outpatient consultation codes 99241-99245 are appropriate. If the pediatrician admits the child, report a hospital admission (CPT 99221 -99223 ) rather than a consultation. When billing the hospital admission, however, consider the work involved in the consultation as part of the admission process and code accordingly.
When Not To Bill a Consult  
If the ED physician transfers care to the pediatrician, the pediatrician could bill an office visit, 99201-99215, but not a consultation. For example, the ED physician takes one look at a 1-month-old infant with a fever and realizes that a pediatrician must take over the case. He calls the pediatrician and requests that the pediatrician come to the ED.
 
If the pediatrician goes to the ED for the comfort and convenience of the patient, that doesn't necessarily warrant a consultation. For example, a mother calls the pediatrician after hours to say that her 2-year-old has burned his hands on a vaporizer. The pediatrician calls back and tells the mother to place the child's hand in a bowl of ice water and go to the ED immediately. The ED is crowded due to a recent traffic accident, however, and the child is triaged with low priority. The mother tells a nurse she's going to call the pediatrician again. The nurse tells the ED physician and the pediatrician comes to the ED to see the child. In this case no consultation code should be billed. The pediatrician may use an ED code (99281-99285), however, if the ED physician doesn't [...]