Wiki INPATIENT CONSULT & SAME DAY SURGERY IN THE OR

[mkndevh@msn.com]

Hi. Anesthesia coder brand new to E/M coding. We recently started billing for a Plastic surgeon who sometimes has an inpatient consult on the same day as a surgery. Is the consult billable if it's on the same day as the surgery? I understand that Medicare and some commercials don't accept the consult codes and he has to meet the 3 R's. If billable and payor doesn't accept the consult code is it appropriate to bill 99221-99223 with -57 modifier in addition to the surgical CPT? Any guidance is appreciated. Thank you.

 

[csperoni]

Some carriers (specifically CMS guidance) advise to use 99221-99223 in this situation. Some carriers will only pay one physician (the attending) for initial 99221-99223 and want any other physicians to use subsequent 99231-99233. And yes, -57 with either initial or subsequent.
Honestly, since so few carriers still permit consult codes and those 3Rs are required, we never use consult anymore.

 

[mkndevh@msn.com]

Thank you.

 

[Orthocoderpgu]

Thank you.

Is the decision to perform the surgery really being made during the inpatient E/M in these cases? ** Pet peeve of mine is coders using the word consultation when they are talking about an E/M that does not meet the requirements for a consultation. Very few actual "consultations" are performed meaning the three R's are being met.