Wiki Pediatric Consult in ER - How to Code

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Maxine

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How should the following be coded for a pediatric patient. There is no Medicare involved here so consultation codes still apply.

Pediatric patient comes into ER and ER doctor calls in child's pediatrician for consultation ...

How should this be coded? ...as a consult (99245)? as an E&M outpatient
(99215) visit? as an ER visit?

Maxine Cohen
646-227-3421
cohenm@mskcc.org
 
Only the ER Doc knows why he called in the Pedi physician. Either he wanted an opinion on how to care for the child (consult) or he wanted the Pedi to take over and eval/treat the child (refer)

From what you said "ER doctor calls in child's pediatrician for consultation", the ER Doc only wanted the Pedi to assist and give an opinion. So code the Pedi services as a out-pt consult

But if the ER is calling in the Pedi it's probably not for a runny nose. In most cases, the ER Doc is calling the Pedi to come treat the child. If so, then that's not a consult

Look in the note and see what the ER Doc documented: "Called Pedi for consult" or "called Pedi to examine pt". The Pedi can not provide a consult if he was not asked for a consult.
 
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