Elizabeth Fredette
New Member
Can a non ER physician use 99281-99285? We have a few orthopedic doctors and general surgeons that consult patients while they are in the ER and are charging 99282. Is this correct?
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Q&A Consultations in the ER
- Thread starter Elizabeth Fredette
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Alicia Scott
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The E/M section is divided into broad categories such as office visits, hospital visits, and consultations. (per the AMA Guidelines) So, if this is a consult why would they not use a consult code?
What I would do is see what 99282 pays vs a consult code. If they are actually doing a consult....
Another thing to consider is what is the ER physician coding for?
AMA Guidelines:
A consultation is a type of evaluation and management service provided at the request of another physician or appropriate source to either recommend care for a specific condition or problem or to determine whether to accept responsibility for ongoing management of the patient's entire care or for the care of a specific condition or problem.
A physician consultant may initiate diagnostic and/or therapeutic services at the same or subsequent visit.
A "consultation" initiated by a patient and/or family, and not requested by a physician or other appropriate source (eg, physician assistant, nurse practitioner, doctor of chiropractic, physical therapist, occupational therapist, speech-language pathologist, psychologist, social worker, lawyer, or insurance company), is not reported using the consultation codes but may be reported using the office visit, home service, or domiciliary/rest home care codes as appropriate.
The written or verbal request for consult may be made by a physician or other appropriate source and documented in the patient's medical record by either the consulting or requesting physician or appropriate source. The consultant's opinion and any services that were ordered or performed must also be documented in the patient's medical record and communicated by written report to the requesting physician or other appropriate source.
If a consultation is mandated (eg, by a third-party payer) modifier 32 should also be reported.
Any specifically identifiable procedure (ie, identified with a specific CPT code) performed on or subsequent to the date of the initial consultation should be reported separately.
If subsequent to the completion of a consultation the consultant assumes responsibility for management of a portion or all of the patient's condition(s), the appropriate Evaluation and Management services code for the site of service should be reported. In the hospital or nursing facility setting, the consultant should use the appropriate inpatient consultation code for the initial encounter and then subsequent hospital or nursing facility care codes. In the office setting, the consultant should use the appropriate office or other outpatient consultation codes and then the established patient office or other outpatient services codes.
To report services provided to a patient who is admitted to a hospital or nursing facility in the course of an encounter in the office or other ambulatory facility, see the notes for Initial Hospital Inpatient Care (page 15) or Initial Nursing Facility Care (page 25).
For definitions of key components and commonly used terms, please see Evaluation and Management Services Guidelines.
What I would do is see what 99282 pays vs a consult code. If they are actually doing a consult....
Another thing to consider is what is the ER physician coding for?
AMA Guidelines:
A consultation is a type of evaluation and management service provided at the request of another physician or appropriate source to either recommend care for a specific condition or problem or to determine whether to accept responsibility for ongoing management of the patient's entire care or for the care of a specific condition or problem.
A physician consultant may initiate diagnostic and/or therapeutic services at the same or subsequent visit.
A "consultation" initiated by a patient and/or family, and not requested by a physician or other appropriate source (eg, physician assistant, nurse practitioner, doctor of chiropractic, physical therapist, occupational therapist, speech-language pathologist, psychologist, social worker, lawyer, or insurance company), is not reported using the consultation codes but may be reported using the office visit, home service, or domiciliary/rest home care codes as appropriate.
The written or verbal request for consult may be made by a physician or other appropriate source and documented in the patient's medical record by either the consulting or requesting physician or appropriate source. The consultant's opinion and any services that were ordered or performed must also be documented in the patient's medical record and communicated by written report to the requesting physician or other appropriate source.
If a consultation is mandated (eg, by a third-party payer) modifier 32 should also be reported.
Any specifically identifiable procedure (ie, identified with a specific CPT code) performed on or subsequent to the date of the initial consultation should be reported separately.
If subsequent to the completion of a consultation the consultant assumes responsibility for management of a portion or all of the patient's condition(s), the appropriate Evaluation and Management services code for the site of service should be reported. In the hospital or nursing facility setting, the consultant should use the appropriate inpatient consultation code for the initial encounter and then subsequent hospital or nursing facility care codes. In the office setting, the consultant should use the appropriate office or other outpatient consultation codes and then the established patient office or other outpatient services codes.
To report services provided to a patient who is admitted to a hospital or nursing facility in the course of an encounter in the office or other ambulatory facility, see the notes for Initial Hospital Inpatient Care (page 15) or Initial Nursing Facility Care (page 25).
For definitions of key components and commonly used terms, please see Evaluation and Management Services Guidelines.
Elizabeth Fredette
New Member
Thank you so much Alicia! I really appreciate you taking the time to explain that. What was tripping me up was using POS 23 with consult codes.