Wiki Consultations - ER with abdominal pain

[cbyrne@urologic-consultants.com]

Scenario:

Mr. Smith is a well known kidney stone patient to our practice. He goes to the ER with abdominal pain. Our Physicians Assistant rounds on him and decides he needs an ESWL the next day. They physicians comes later and sees the patient agrees with findings and signs off on the PA's notes. We round on him again in the morning and do the ESWL in the afternoon. What would you bill? Remember, this is a split/shared visit between a PA and a physician.

A consultation code 99244
or
An established patient code 99214
or
A new patient 99204

Subsiquent question:
Can you bill for the morning visit the day of surgery? 99212?

 

[Bjohnse1]

I don't see the consultation (99243) being an option as no provider requested the opinion of another provider regarding the patients treatment or condition. Other than that, I wouldn't know. My first guess would be the 99214, but again, just my opinion.

 

[mitchellde]

I don't see the consultation (99243) being an option as no provider requested the opinion of another provider regarding the patients treatment or condition. Other than that, I wouldn't know. My first guess would be the 99214, but again, just my opinion.

If the patient was an ER patient the entire time then you use ER levels 99281-99285. No yo a visit level the day of the procedure.

 

[sivagurulingam]

Hi,
I agree with ER codes

 

[cbyrne@urologic-consultants.com]

consult not ER

The patient is admitted to observation status and moved from the ER. So my scenario would keep ER codes out. I am trying to focus my attention on if you can bill a split/shared visit between a mid-level provider and a physician when billing a consultation code. From everything I find you cannot. Thoughts?

 

[mitchellde]

No you cannot share a consult or initial visit or new patient encounters.

 

[balamuruganm]

consult not ER

As above details we can code only ED 99281 to 99285 not a consultation or Outpatient visit

Regards,
Balamurugan M,CPC,COC,CCS

 

[mitchellde]

The patient is admitted to observation status and moved from the ER. So my scenario would keep ER codes out. I am trying to focus my attention on if you can bill a split/shared visit between a mid-level provider and a physician when billing a consultation code. From everything I find you cannot. Thoughts?

If the order was written to convert to observation then you are correct you cannot use the ER levels. But you also cannot share a consult. This would not qualify for a consult anyway as the patient is already established with your practice for kidney issues. The best it gets here is outpatient encounter which can be shared. Unless your provider is the one that admitted the patient to observation status.