Wiki Billing ER Consults

[ssaldiv2]

Which codes are used to bill consultations by non-ER physicians in the ER for payers who do not accept consultation codes?

I know the 9928x series is reserved for Emergency physicians only. The outpatient consultation codes are accepted by only a handful of payers.

 

[mitchellde]

The 9928x are not for ER physicians only. They are used by any provider that sees the patient in the ER setting. These are the codes you use when the ER provider requests that your physician see the patient in the ER.

 

[RebeccaCross*]

Debra is correct. Below is guidance from CMS.

A. Use of Emergency Department Codes by Physicians Not Assigned to Emergency Department

Any physician seeing a patient registered 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.

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F. Emergency Department Physician Requests Another Physician to See the Patient in Emergency Department or Office/Outpatient Setting

If the emergency department physician requests that another physician evaluate a given patient, the other physician should bill an emergency department visit code. If the patient is admitted to the hospital by the second physician performing the evaluation, he or she should bill an initial hospital care code and not an emergency department visit code.

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https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c12.pdf