tci ED Coding & Reimbursement Alert - 2014 Issue 5

Reader Question: Check the Payer before Reporting a Consultation Code

Question: What is the right code to use in the following scenario? Patient presents to the emergency room and a specialist consult is requested. The specialist (i.e. cardiologist, gynecologist) performs the consultation in the ED setting and the patient is not admitted. Florida Subscriber Answer: CPT® still contains consultation codes, so if that is the service performed by the specialist, they should use the appropriate outpatient consult code 99241-99245. Medicare does not recognize consultation codes, so if it is a Medicare patient, they would report using the ED E/M code.  ...

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