Wiki Toxicology Consult in the ED VS Inpatient

[territraynor]

Hope someone can help. We have ED physicians who regularly get call for inpatient or Emergency Room Toxicology Consults. Some payers allow the consult codes, however most do not. Can we use Inpatient codes (99221-99223, 99231-99233) for those patients that are being seen inpatient?, or do we have to use outpatient visit codes (99201-99205, 99211-99215)?

 

[TThivierge]

Hi Territraynor
Are you referring type of lab test to see if patient is abusing drugs or substance abuses? Id use the CPT codes where the patient is located EMR or Inpt. status. the CPT 99202 to 99215 is for est or new patient in clinic or doc s office in OP setting. EMR have own CPT codes.Depending on siutation in EMR. The ER doc may contact the psychiatrist on call for the day and he orders the lab to prove if pt abusing. Or ER doc can order such labs. Also CPT observation codes can be used if ER doc decides to watch the patient a bit before transferring him or her to Inpt psych ward. Yes use the CPT according to setting
Lady T

 

[territraynor]

Hi Territraynor
Are you referring type of lab test to see if patient is abusing drugs or substance abuses? Id use the CPT codes where the patient is located EMR or Inpt. status. the CPT 99202 to 99215 is for est or new patient in clinic or doc s office in OP setting. EMR have own CPT codes.Depending on siutation in EMR. The ER doc may contact the psychiatrist on call for the day and he orders the lab to prove if pt abusing. Or ER doc can order such labs. Also CPT observation codes can be used if ER doc decides to watch the patient a bit before transferring him or her to Inpt psych ward. Yes use the CPT according to setting
Lady T

Thank you for the response, you were the only one who responded. I am not talking about labs. I have Emergency Room physicians who regularly get called either the Peds ED or Patients rooms to do consults for toxicology. Many payers do not pay for consults (99242-99245) So we either us the ED E&M or Office or other outpatient visit codes (99282-99285 or 99202-99215). I was asking if they patient is being seen, just of E&M, inpatient can an ED physician use an inpatient code (99252-99255)

 

[TThivierge]

Hi Terri
Yes if EMR doc is called down to treat the patient whose body is in a bed yes I d add subsequent CPT code 99231 99233 . Most Medicare and Medicaid payers do not cover inpt. consults plus may have to be preapproved. The ER doc could monitor progress, address new problem or revise recommendations. The payer may look at consult codes from of specialist practice like Orth, Cancer, etc. but it says coordinating care might cover a ER doc. This is in CPT manual pg21. However, the hospital policy maybe different issue on this...so check that too. Also note most CPT codes can be done by any medical doctor MD or DO status.
I hope I helped you
Lady T