Wiki ER CONSULTS?

[kcoover@capefearvalley.com]

patient was seen in er and the pediatrician recommended transfer to another facility is this a 99253 charge ? It has been rejected. I

 

[CBLENNIE]

99253 is for an inpatient POS, for outpatient consults (including the ER) the code range is 99242-99245.

Also, many state Medicaid programs and commercial insurance companies stopped accepting any consult CPT codes 99242-99245 and 99252-99255 when Medicare decided they would no longer cover these CPT codes. They stopped covering consult codes since they were being billed incorrectly the majority of the time based on the strict guidelines/requirements for a visit to be considered a consult rather than a regular outpatient/inpatient E&M.

So, if you change the code to 99243 and it is accepted by the clearinghouse but is then denied by the payer it may be because they do not cover consult CPT codes.