Pediatric Coding Alert

Question: I have a doctor who is often called in to perform preoperative exams on children who are in a short-stay observation unit for a procedure that will be performed by another physician. Can I use hospital E/Ms? The patients aren't technically admitted. I haven't been billing at all.

Florida Subscriber
Answer: The doctor is performing consultations and you should bill them as such (99241-99245). Because the child has not been admitted, use the outpatient codes. Another physician is requesting that the doctor perform preoperative clearance. Whether these exams are performed in the office a few days before surgery or in the hospital prior to surgery, the doctor is being a consultant. The surgeon is billing for his or her work, and the hospital is billing the facility fee. You can bill for your doctor's fee too.
 
Note: Consultation codes reimburse better than hospital or outpatient visits.
Answers to Reader Questions reviewed by Richard H. Tuck, MD, FAAP, founding chairman, AAP coding and reimbursement committee; and Thomas Kent, CMM, CPC, president, Kent Medical Management, Dunkirk, Md.