Wiki ER Consults

[joanne71178]

I want to confirm I am coding the correct level for this ER Consult.

I can pull only 3 HPI from an ER consult, Detailed ROS w/ 2 systems and a Comp PFSH.

8 Organ Systems under the PE

2 diagnosis, 3 data points and the patient is to have an Open Hip Surgery for a fx; so a High Risk.

I code this as a 99283.

Would anyone code this differently?

 

[MnTwins29]

With 3 HPI elements, the level of the history component would be Expanded Problem Focused. Since this is an ED patient, you can code 99283 with this level. With ED codes requiring 3 of the 3 key elements to assign that level, I only looked at history since that was the lowest of the 3.

Hope this helps.

 

[cheyenne102]

I would code this sinario differently.

Please see below. This is a response I received yesterday



Yes, you can bill the 99201-99215 range for Medicare with the ED place of service 23. Similarly, you can bill the 99241-5 range to other carriers, but I doubt they'll do you the favor of crosswalking it if they don't cover consult codes. You'll have to check the individual carrier's policy on that.
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[joanne71178]

With our software the POS/Location is ER I have to code with an ER consult code or it will be kicked back. I agree with the 99283. Only if the docs would give a duration I could bump this up to a level 4. Thanks for the advice!

 

[mitchellde]

Read the MCM with regard to ER encounters, it states that when your provider is called into the ER to see a patient you must use the ER visit levels 99281-99285 not the 99201-99215 codes.

 

[sullivak]

Thanks for setting me straight on this, Debra. I found the reference you are talking about -

According to CMS Transmittal 1875 "If the ED physician requests that another physician evaluate a given patient, the other physician should bill an emergency department visit code. If the patient is admitted to the hospital by the second physician performing the evaluation, he or she should bill an initial hospital care code and not an emergency department visit code."

I've fixed this one in my brain!