Wiki Hospital initial hospital care vs. Hospital inpatient consult

[navila0508]

We are Gastro specialists with our own practice.
A doctor is on call weekly at the hospital.
I am about to be certified and have started to question how we bill. I took over the billing for hospital visits. Im confused and wondering if I am billing correctly.

Ex: Dr GI is asked to consult on a patient by Dr ER/ADMIT.
We have been billing with 99221-99223. Is this correct? I think we should be using a 99251-99255 instead..

Ex: Dr GI sees patient in ER and admits patient. Procedures and subsequent visits are done. What E&M code should I use for the initial visit?
99221-99223 ? 99251-99255?

So confused...

 

[melbad]

If the patient is Medicare or Medicaid- consult codes are not used, since they are not accepted by those payors. Initial Hospital codes would be accurate for those payors. If the patient has private insurance, check with your payor to see if they still accept IP consult codes and go from there.

Melba DeLesDernier, CPC
OU Compliance Office
DeLesDernier Coding and Consulting

 

[navila0508]

Thank you so much for that reply. Very helpful I can relax a little more

 

[jdibble]

Ex: Dr GI sees patient in ER and admits patient. Procedures and subsequent visits are done. What E&M code should I use for the initial visit? 99221-99223 ? 99251-99255?

If your doctor is called to consult by the ED doctor and then he admits the patient, he would not bill a consult code for the non-medicare patient either - it would be an Initial Admit code - 99221-99223. If he is admitting the patient he is taking over the patient's care and his service is no longer considered a consult. For Medicare patients he would append an AI modifier to this code also, as the admitting doctor.