pedscoder21
Guru
Scenario:
Pediatric surgery physician is consulted to the ED and determines that the patient will be admitted to the hospital as an inpatient and submits an order for admission.
Question:
If this 'consult' note by the pediatric surgery physician does not meet the detailed/comprehensive, 3 out of 3 guidelines that initial inpatient 99231-99233 require, would you bill this as a consult (since it originated as a consult from the ED provider), or, a subsequent visit? If you can provide me documents I would greatly appreciate it.
I do have documents from the AMA that state, "if the level of history and PE performed and documented is expanded or problem focused, initial inpatient hospital care must be reported using subsequent hospital visit codes 99231-99233 because the required key components for code 99221 (ie, at least a detailed history and detailed examination) have not been met." The problem I have is that I do not have specific guidelines on consults turning to initial care.......which is basically every time my physicians see patients (patient always enters to ED and pediatric surgery is consulted).
Thanks!
Pediatric surgery physician is consulted to the ED and determines that the patient will be admitted to the hospital as an inpatient and submits an order for admission.
Question:
If this 'consult' note by the pediatric surgery physician does not meet the detailed/comprehensive, 3 out of 3 guidelines that initial inpatient 99231-99233 require, would you bill this as a consult (since it originated as a consult from the ED provider), or, a subsequent visit? If you can provide me documents I would greatly appreciate it.
I do have documents from the AMA that state, "if the level of history and PE performed and documented is expanded or problem focused, initial inpatient hospital care must be reported using subsequent hospital visit codes 99231-99233 because the required key components for code 99221 (ie, at least a detailed history and detailed examination) have not been met." The problem I have is that I do not have specific guidelines on consults turning to initial care.......which is basically every time my physicians see patients (patient always enters to ED and pediatric surgery is consulted).
Thanks!