I have a coding scenario I've never faced before, where our ED physican performed an E/M service in the emergency room and then an inpatient consultation on the same date of service. Would really appreciate help so I can code this correctly.
Our physician did emergency department E/M. Afterwards, on the same day, a surgeon who we do not code for admitted the patient to inpatient status. After that, still on the same date of service, our ED physician did an inpatient consultation (non-Medicare) on this case. What can I code? The CPT book says that "when an inpatient consultation is performed on a date that a patient is admitted to a hospital or nursing facility, all evaluation and management services provided by the consultant related to the admission are reported with the inpatient consultation code (99251-99255)." Is the original E/M service performed in the emergency room considered to be "related to the admission" or does "related to the admission" refer only to services that occurred after the patient was in inpatient status? Do we have to bundle the emergency department service into the much-lower-paying inpatient consultation code? If so, do we have the alternative of simply billing the emergency department charge and not billing for the consultation?
If the original E/M service is not "related to the admission" then I assume we can bill for both the E/M service and the inpatient consultation, using a modifier 25?
Thanks for any clarification you can offer.
Our physician did emergency department E/M. Afterwards, on the same day, a surgeon who we do not code for admitted the patient to inpatient status. After that, still on the same date of service, our ED physician did an inpatient consultation (non-Medicare) on this case. What can I code? The CPT book says that "when an inpatient consultation is performed on a date that a patient is admitted to a hospital or nursing facility, all evaluation and management services provided by the consultant related to the admission are reported with the inpatient consultation code (99251-99255)." Is the original E/M service performed in the emergency room considered to be "related to the admission" or does "related to the admission" refer only to services that occurred after the patient was in inpatient status? Do we have to bundle the emergency department service into the much-lower-paying inpatient consultation code? If so, do we have the alternative of simply billing the emergency department charge and not billing for the consultation?
If the original E/M service is not "related to the admission" then I assume we can bill for both the E/M service and the inpatient consultation, using a modifier 25?
Thanks for any clarification you can offer.