Wiki Hospitalist Coding Consultations For Commercial Payers

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MyAAPC25

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What CPT code and POS code, is used for a Consult/Pre-Op, in a hospital setting, performed by a primary care provider?
Also, what CPT code and POS code is used for a Medical Evaluation of a mental health patient, in a hospital setting, performed by a primary care provider?
(The PCP is not the admitting physician)
 
it depends on the status of the patient when your provider rounded on them. Was the patient in the ER? or in observation status versus an actual in patient admission.... Your CPT book has the POS codes in the very beginning of the manual...
21 inpt... 22 outpt... 23 emergency room. some carriers such as MI medicaid do not pay for subsequent observation visits (CPT 99224 - 99226), medicaid only pays for the initial consult; so some coders change the E/M code to a office/outpatient setting E/M 99212-99215 depending on the documentation.
 
only attending physicians can bill inital obs codes 99218-99220 so if you Dr. was called in to see a pt that is in observation status for a consult he would bill out from CPT code range 99212-99215... if the pt is fully admitted inpatient he would bill out from CPT range 99221-99223.
If he saw the patient in emergency room status (meaning patient has not been placed into observation status or actually admitted to in patient status) he would bill out CPT 99281-99285 range.
 
forgot to mention re: your mental health question. I don't have experience in this area so I'll leave this up to the experts.
 
That makes more sense now. Those same rules seem to be applicable for a health assessment of a patient who?s awaiting medical clearance, before being admitted for inpatient mental health treatments. Thank you for your help.:)
 
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