Wiki Tom W., CPC

[pipertom]

Greetings, I need a little help with a hospital charge question....
Est. patient(Medicare) with several chronic problems presents to the ER via ambulance.
The ER phy. contacts the PCP and requests a consult IN THE ER DEPT. regarding her condition and care.
The PCP sees the patient and determines she should NOT ber admitted and she is released from the ER home.
Can the PCP charge for a consult in the ER department when the patient is not admitted?
If so, considering Medicare, what CPT would be used?
If not I would think the standard ER CPT codes would apply for the visit but I'd then like to know can you EVER do a consult in the ER and if so under what conditions?
Thanks for all the help you have given me in the past. This site is a mainstay for my "difficult" coding issues and I can almost always find guidance here. Keep up the work.
Thanks,
Tom in TN

 

[mitchellde]

in the MCM manual there is a section that discusses this very situation. If the ER provider requests your physician to come and see a patient then you must use the ER visit levels for the claim. It also states that an ER provider does not request consults. To bill a consult there are 3 criteria, you must have a request to address a problem or concern the requesting physician has and you must provide a written report back to the requesting provider to detail your findings. Also as the patients PCP you are not being consulted to see a patient regarding unknown issues, you are being asked to come and see your patient.