Wiki Billing Consult for Emergency Room

[bedington]

I have a doctor that wants to know if he can bill an outpatient consult code when he is called to the emergency room by the emergency room physician to consult on a patient there. This would be for someone who does not get admitted to either observation or inpatient.
Also, can my physician ever bill the emergency room code of 99281 to 99285 even if he is not the ER doc.
I just get confused on this one.

 

[pedscoder21]

Yes, your physician can bill a consult as long as he/she has met all the requirements of a consultation service.

You would bill the ER codes for the ER physician. You would only be able to use the ER codes for non-ER physicians if the payer requests this behavior.

 

[Bready]

Per Medicare guidelines, which all or nearly all insurance companies go by, "any physician seeing a patient in the emergency department may use emergency department visit codes (for services matching the code description) It is not required that the physician be assigned to the emergency department."

Also, Medicare did away with consultation codes in 2010. Some commercial insurances are now following Medicare's lead. You would need to contact the patient's insurance to see if they still allow consult codes.

Your physician may use the ER codes if he saw the patient in the ER.