Pulmonology Coding Alert

Question: Our pulmonologist is sometimes on-call for the emergency department (ED). He thinks we should bill from the Office or Other Outpatient Consultations series (99241-99245). Are these correct codes for a consultation in the ED?

Kansas Subscriber

Answer: You are correct to use codes 99241-99245 to report true consultations that occur in the ED. Many pulmonologists mistakenly believe that outpatient consults should be used for office visits only. However, such consultations may occur in any outpatient environment.

The consultation codes should be reported only when the criteria mentioned in the article "Solve the Consultation Mystery" on page 11 are met. It is often the case in the ED that the pulmonologist takes over care without rendering an opinion. In this case, you should use another code. The Medicare Carriers Manual instructs physicians who perform services in the ED to report the appropriate-level ED code (99281-99285) even when the ED physician has also seen the patient. However, many carriers do not accept ED codes from two physicians regarding the same patient.

In such cases, many coding specialists advise physicians to use the appropriate new or established patient code (99201-99215). You may need to appeal any ED code denials to reinforce to carriers that physicians other than the ED physician are supposed to use these codes.

Advice for You Be the Coder and Reader Questions was provided by Carol Pohlig, BSN, RN, CPC, at the University of Pennsylvania department of medicine in Philadelphia; and Anthony M. Marinelli, MD, FCCP, chairman of the American Thoracic Society's Clinical Practice Committee.