Wiki Which type of E/M visit?

[jeanome]

I think I know which E/M visit type to code for this, but I'd really like some confirmation. I'm trying to figure out what E/M visit type the *surgeon* should code for this sequence of events:

- patient gets CT in hospital outpatient setting, confirm appendicitis, sent to ED for pre-admission workup (cxr, labs, ekg).
- see various ED staff and ED physician in ED
- seen by surgical *resident* in ED, resident performs H&P
- patient admitted, sent to inpatient room
- patient immediately sent back down to pre-op area to prep for surgery
- seen by *surgeon* in pre-op area, who reviews chart, briefly describes procedure, no real physical exam
- patient has appendectomy, sent back up to room after recovery
- seen by surgical *residents* the next day in follow-up
- discharged (never seen by surgeon again in hospital)

What does the surgeon code for an E/M services under this scenario? I'm guessing that he/she should charge an admission (99221-99223) assuming they reviewed and supplemented the surgical resident's H&P done in the ED, or should it be some other E/M service? (or no E/M service?) And I don't think the surgeon could charge a discharge given that he never saw the patient before discharge, right?

What do you all think?

- jean

 

[FTessaBartels]

Surgeon in a teaching hospital

If the surgeon has included the appropriat attestation statement to the resident's note, then the surgeon may bill the Initial visit (might be inpt ... but might be observation ... we do all our appys - unless perforated - as outpatient procedural short stay).

Any E/M visits AFTER surgery are bundled into the global surgical package.

Hope that helps.

F Tessa Bartels, CPC, CEMC