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dbeedlow@orlandooncology.

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Posts: 5
Reply with quote  #1 
I have conflict information.  One source of information has stated, "auditing class" Only one physician should bill CPT codes 99281-99285 for an evaluation of a patient in the ED per visit.  Refer to consultation codes and office/other outpatient visit codes in cases where other physicians besides teh attending ED physician evaluate the patient." 

Under the CPT coding section 100-4,12,30.6.11. It differs.

event: The patient's personal physician was called into the ED by the ED physician. They decided to send the patient home after 4 hours.  The ED physician will bill the ED E/M. My physician can bill the ED E/M section also according to the CPT book; "If the ED physician, based on the advice of the patient's personal physician who came to the emergency department to see the patient, sends the patient home, then the ED physician should bill the appropiate level of emergency dept. service.  The patient's personal physician should also bill the level of emergency department code that describes the service he or she provided in the emergency department."

So which one is correct?

Debbie
pjensen

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Reply with quote  #2 
My understanding is that the rules have been changed such that the consultant would bill for an ER visit.  PJ.

E. Physician Billing for Emergency Department Services Provided to Patient by Both Patient’s Personal Physician and Emergency Department Physician

If a physician advises his/her own patient to go to an emergency department (ED) of a hospital for care and the physician subsequently is asked by the ED physician to come to the hospital to evaluate the patient and to advise the ED physician as to whether the patient should be admitted to the hospital or be sent home, the physicians should bill as follows:

• If the patient is admitted to the hospital by the patient’s personal physician, then the patient’s regular physician should bill only the appropriate level of the initial hospital care (codes 99221 - 99223) because all evaluation and management services provided by that physician in conjunction with that admission are considered part of the initial hospital care when performed on the same date as the admission. The ED physician who saw the patient in the emergency department should bill the appropriate level of the ED codes.

• If the ED physician, based on the advice of the patient’s personal physician who came to the emergency department to see the patient, sends the patient home, then the ED physician should bill the appropriate level of emergency department service. The patient’s personal physician should also bill the level of emergency department code that describes the service he or she provided in the emergency department. If the patient’s personal physician does not come to the hospital to see the patient, but only advises the emergency department physician by telephone, then the patient’s personal physician may not bill.

F. Emergency Department Physician Requests Another Physician to See the Patient in Emergency Department or Office/Outpatient Setting

If the emergency department physician requests that another physician evaluate a given patient, the other physician should bill an emergency department visit code. If the patient is admitted to the hospital by the second physician performing the evaluation, he or she should bill an initial hospital care code and not an emergency department visit code.

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Reply with quote  #3 
Thank you Dr. Jensen, I appreciate you taking the time to clarify. 
Debbie
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Reply with quote  #4 
I am a new ED coder and I am a little confused on who can bill what.  If the patient comes into the ER, the ER Dr. A wants to admit patient inpatient, he calls the Dr. B who is on call on the inpatient floor who accepts the patient as inpatient, can I bill the ER for facility and the ER doctor and also bill the inpatient facility and Dr. B if this occurs on the same day.  We are an Acute Care Hospital.  You help would be greatly appreciated.  Thanks
pjensen

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Reply with quote  #5 
The ER doc can bill for the ER visit. The admitting doc would bill for the admission H&P. Doesn't matter if they are both in the same group or not. These are different, complementary E/M services. PJ.
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Reply with quote  #6 
Can you please provide your resource / reference for the following ER Consults (CMS):

If the patient is being admitted to YOUR service, you would do an admission H&P and attach the AI modifier. If the patient is going to be admitted by another doctor, you will have to find out if he or she is going to be admitted under observation status or as an inpatient. If the patient is admitted for observation, you would use either the new office patient codes or the established office patient codes (depending on whether or not the patient has been seen by you or your group in the past three years). If the patient is being admitted as an inpatient, you would perform and document your "consult" as an H&P (99221, 99222 or 99223) without attaching the AI modifier.

I cannot find this language in any official CMS guideline.  It seems to state two options:
1) If you consult then decide to admit then you bill the Initial Hospital code with AI modifier.
2) If another MD admits, then you bill the ER code because that's where the patient was at the time you did you consult.

I need to have the guidelines / reference which indicates we need to find out if the patient is going to be admitted and if so to what status to determine the correct type of service to bill.

Thank you.
pjensen

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Reply with quote  #7 
The above example is for a Medicare patient.  Since Medicare no longer pays for consult services, the "consult" would be billed as either an admission H&P with AI (if the consultant admits the patient as an inpatient to his or her service), or as an ER visit (if the patient is sent home--the rules have been changed to allow more than one ER visit per patient per day) or as admission H&P without AI modifier (if patient is being admitted as inpatient on another service) OR as a new or established office visit, if the patient is being admitted under observation status.  See how simple things are now that those confusing consult codes have been eliminated?  PJ.
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Reply with quote  #8 
The guidelines seem to state that you pick the code based on the location of the patient at the time of the consult.  So for Medicare (who does not accept the consult codes), if your consult is performed in the ER, but the patient is subsequently admitted by the Hospitalist (not you), would you bill an ER code or would you bill an initial hospital code (99221 - 99223) without the -AI modifier?  

The guidelines are not very clear in this scenario.  The examples they provide are either when you consult in the ER then you admit.  Or you consult in the ER and the patient is discharged.  What happens when you consult in the ER and a different provider subsequently admits?  You could argue that the patient's status at the time of your consult was registered to the ER, therefore you should bill an ER code....

Thank you for your clarification.
lwalters@chp-dod.com
Reply with quote  #9 

Dr. Jensen,

I would like clarification of your Hospital Consult Algorithm on how to correctly bill for a Medicare patient Consult within the ED.  There are conflicting opinions within our coding group.  Here is the scenario; Medicare patient is consulted on in the ED by an Ortho provider.  Following the Ortho consult, the patient is later admitted by a member from lets say a Hospitalist group.  Does the Ortho provider bill for an ED service code or an Initial Visit code 9922X without Modifier AI?

Here is what CMS say's...The instructions in Medicare's IOM manual 104 c12, 30.6.11 state:

F. Emergency Department Physician Requests Another Physician to See the Patient in Emergency Department or Office/Outpatient Setting
If the emergency department physician requests that another physician evaluate a given patient, the other physician should bill an emergency department visit code. If the patient is admitted to the hospital by the second physician performing the evaluation, he or she should bill an initial hospital care code and not an emergency department visit code.

Thank you for your time and any assistance you might be able to provide.

LeAnne,




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Reply with quote  #10 
I practice in a rural environment and am employed by both an ER group and a hospitalist group. On occasion I work for both companies at the same time. So, if I see a patient in the ER who needs to be admitted, can I bill for both the ER visit and subsequently the H&P?

After all, I am functioning in 2 different specialties, AND working for 2 different companies.

Thank you. 
missicbc

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Posts: 3
Reply with quote  #11 
I appreciate you taking the time to clarify.   Debbie..............


_________________

Fifa 15 Coins 
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Reply with quote  #12 
I code the Hospitalist doctors.
My question is one of my doctors saw a patient in the ED on 08/01/2018, he did not admit the patient.  The next day the same doctor saw the patient again in the ED 08/02/2018 and admitted the patient. He did an H&P on the patient. On 08/03/2018 patient was discharged.  Do I code 08/01/2018 CPT 99281/ on 08/02/2018 CPT 99232 and on 08/03/2018 99238?

Thanks Brenda
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