ED Coding & Reimbursement Alert - 2021 Issue 2
Reader Questions: Dissect Office or Consult E/M Choice
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Article Overview
This reader Q&A explains the general reporting distinctions involved when a surgeon evaluates a patient and sends information to a requesting provider. It discusses the roles of interprofessional consultation services versus face-to-face consultation and office/outpatient E/M reporting, including the impact of payer policy and Medicare recognition. The article is aimed at coders, billers, and clinicians who need to understand which broad category of E/M service may apply in a referral or consult scenario.
Why This Topic Matters
Choosing between consultation-related and office/outpatient E/M reporting affects claim accuracy and payer acceptance. The article helps readers understand the general service categories involved and why payer-specific rules can change the reporting approach.
What You Will Learn
- How the article frames the distinction between interprofessional services and consultation E/M reporting
- Why payer policy can affect whether consultation codes are recognized
- What broad documentation and service-setting considerations are discussed for referral-related E/M services
- How office/outpatient E/M and consultation E/M categories are contrasted at a high level
Who Should Read This
- Medical coders
- Billing staff
- Physicians
- Other qualified health care professionals
Codes Discussed
Code Ranges Discussed
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