Wiki Pediatric fetal consult

[BridgetW]

I code for a pediatric surgeon. Recently he did E/M on 2 patients who are expecting children with known fetal complications such as duodenal obstruction and gastroschisis. He performs an exam on these pts, discusses ultrasound findings, and how tx of the baby once born.

My question is, since he is a pediatric surgeon and the pt (baby) isn't born yet, named, listed on insurance, etc... can we charge for these visits? I'm thinking no, but I'm new to pediatric coding so I was hoping someone might tell me if there is a way to bill these that I am unaware of!
Thank you

 

[FTessaBartels]

Consultation billed under mother's name

The only patient that exists today is the mother. Our Pediatric General Surgeons bill these prenatal consults under the mother's name. Most are coded based on time spend in counselling/coordination of care.

Example: I spent 45 minutes with Mrs Patient today. The entire visit was spent in counselling/coordination of care re her unborn child's recent ultrasound diagnosis of CDH. We discussed treatment options and likely outcomes. All her questions were answered and a report will be sent to her OB/GYN for coodinating delivery at a facility that will be able to handle the complex care of a newborn with CDH.

Such documentation supports coding 99244 (assuming carrier accepts consults).

Hope that helps.

F Tessa Bartels, CPC, CEMC

 

[BridgetW]

Thank you! This makes sense. & even if the carrier doesn't accept consults, we can charge an E/M based on time, correct?
Education coordinators in our office developed a crosswalk from consult code to an E/M code when the carrier will not pay consults....
For example

99244 = 99214....
I haven't always agreed with this, but maybe it is possible.

Either way, I will inform my provider that this is the best way to document these visits in the future!
Thank you!!!!