Wiki E/M coding

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kristilm

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We had a patient that was seen by one of our doctors in the office on 10/28/2014, it was a return visit. Then later that afternoon this same doctor, who was on call, got a consult request for this same patient, but as an in patient. After she had left our office apparently later that day she went to the ER and and the physician that saw her there is the one who admitted her. How do I code these two separate visits and can I code both or do I just code the inpatient visit. Thanks for any help I can get with this. :confused:

Kristi
 
Hi Kristy, you will combine the documentation for the two visits and bill an inpt E/M. Make sure your doc is documenting "I saw this patient in my office earlier today..." etc..
If you bill a 9921X then a 9922X for the same date of service the insurance will deny the claims.
 
Is this patient being admitted for the same problem they saw the doctor earlier that day? If it is a seperate issue then you would use the 25 modifier on the second service.
 
This is considered a combined visit. You would bill the inpt consult code 99251-99255 as longer as the payor covers consults and use both sets of documentation to determine the level of service to bill.
 
many payors do not recognize 99242 etc... consult codes anymore. Here in Michigan only work comps and auto carriers do. MCR did away with them like 4 yrs ago or more and many private payors followed suit. (speaking from 18 years of billing exp).You would use inpt codes 99221 thru 99223 or obs care codes if your doc ordered pt to be put in obs care.
 
Yes you combine the documentation and bill one e/m.

Quick side note. Some payers (who normally pay consult codes) may deny your consult stating that the pt. is not a new pt. ie consult codes are treated as new pt codes and may be inappropriate for use with established pts. I have seen this occur on more that one occasion.
 
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