Birdie625
Networker
Hi - 2-diff situations w/? on the e/m. Pls and thank you in advance and hopefully I have worded all to not cause confusion...as I myself am terribly confused lately.
Situation 1
Ortho PA from clinic was "consulted" to ER to see pt who broke arm. PA talked to MD who also came in and saw pt (Addended the PA's note) and decision for surg made to reduce (outpatient).
The Ortho's note did not have the 3 R's; more so the 1st R. I can see in the record that the ER dr called ortho asking them to see pt, ortho came in & took over care w/surg, and sent pt. home. But to me the Ortho note in and of itself did not say who consulted them ("....asked by Dr X from ER to come in ...."). It just notates, pt presents to ER for xyz, I was asked to come and evaluate.
1) am I missing something re: the 3 R's when it comes to having EMR that ER and Ortho share and have access to? Or does the Ortho note have to 'literally' notate ... "I was asked by Dr X to come see pt"
2) as I was of mindset it did not qual for a consult in ER... AND... ortho took over care.... I was going to use a 9920x code (pt was new). Is this wrong mindset??
3) I didnt think it w/b an ER 9928x code because they took over care and pt ended w/out-pt. surgery.
4) I was told it needed to be a Consult code (d/t POS = 9924x).
5) Ins was a type that does accept consult codes.
*************************
Situation 2
(Ins = Mcare // POS = OBS)
Again - Ortho was called to ER to eval for pain d/t fall; no surg needed, ice/elevation type stuff. (Hospitalist(s) managing other medical issues).
1) same as above, I dont know unless I look throughout the chart for that DOS 'who' called them in. And OFTEN, I cant tell if they saw pt in ER "before" Hosp placed in OBS (to me this = 9928x) ... or... Ortho saw "after" pt was placed in OBS (Ofc/OP codeset).
1a) = the hospitalist admitted and attending. I have read that "only" the admit/attend (the hospitalists) can use the init OBS and SUB OBS codeset, all others use the Office/OP codeset
2) My mindset this would (for ortho) be a Office/OP codeset? But now re-thinking IF called to ER before placed in OBS, it w/b a 9928x code?
3) I was told to use a Subs OBS code.
Any comments on ?s would be appreciated. I will go back to CMS manuals and read up on again as maybe something changed w/rules. I understand the "new" 2021 e/m levels, etc.....but thought that was more to the way e/ms were 'leveled'. Thanks. Birdie
Situation 1
Ortho PA from clinic was "consulted" to ER to see pt who broke arm. PA talked to MD who also came in and saw pt (Addended the PA's note) and decision for surg made to reduce (outpatient).
The Ortho's note did not have the 3 R's; more so the 1st R. I can see in the record that the ER dr called ortho asking them to see pt, ortho came in & took over care w/surg, and sent pt. home. But to me the Ortho note in and of itself did not say who consulted them ("....asked by Dr X from ER to come in ...."). It just notates, pt presents to ER for xyz, I was asked to come and evaluate.
1) am I missing something re: the 3 R's when it comes to having EMR that ER and Ortho share and have access to? Or does the Ortho note have to 'literally' notate ... "I was asked by Dr X to come see pt"
2) as I was of mindset it did not qual for a consult in ER... AND... ortho took over care.... I was going to use a 9920x code (pt was new). Is this wrong mindset??
3) I didnt think it w/b an ER 9928x code because they took over care and pt ended w/out-pt. surgery.
4) I was told it needed to be a Consult code (d/t POS = 9924x).
5) Ins was a type that does accept consult codes.
*************************
Situation 2
(Ins = Mcare // POS = OBS)
Again - Ortho was called to ER to eval for pain d/t fall; no surg needed, ice/elevation type stuff. (Hospitalist(s) managing other medical issues).
1) same as above, I dont know unless I look throughout the chart for that DOS 'who' called them in. And OFTEN, I cant tell if they saw pt in ER "before" Hosp placed in OBS (to me this = 9928x) ... or... Ortho saw "after" pt was placed in OBS (Ofc/OP codeset).
1a) = the hospitalist admitted and attending. I have read that "only" the admit/attend (the hospitalists) can use the init OBS and SUB OBS codeset, all others use the Office/OP codeset
2) My mindset this would (for ortho) be a Office/OP codeset? But now re-thinking IF called to ER before placed in OBS, it w/b a 9928x code?
3) I was told to use a Subs OBS code.
Any comments on ?s would be appreciated. I will go back to CMS manuals and read up on again as maybe something changed w/rules. I understand the "new" 2021 e/m levels, etc.....but thought that was more to the way e/ms were 'leveled'. Thanks. Birdie
