READER QUESTIONS: Never Pass Up a Legitimate Consult

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Note:  The following article synopsis was NOT provided by AAPC. It was created by Find-A-Code/innoviHealth.

Article Overview

This article addresses a reader question about selecting the appropriate evaluation and management reporting category when a hospital contacts an on-call surgeon to see a patient in the emergency department. It explains the scenario at a high level, why the setting and the surgeon’s role matter for coding, and what documentation and service categories are generally involved. The discussion is aimed at coders and billing staff who handle hospital, emergency department, and consultation scenarios.

Why This Topic Matters

Choosing the correct E/M category in hospital and emergency department situations affects claim accuracy and compliance. This topic is especially relevant when a physician evaluates a patient but does not admit the patient, and when consultation documentation requirements may apply.

What You Will Learn

  • How to think about E/M reporting when a surgeon evaluates a patient in the emergency department
  • Why admission status affects the choice among hospital, emergency department, and consultation categories
  • What broad documentation considerations are relevant when a consultation is being considered
  • How to distinguish between services rendered by the surgeon and services provided by other hospital clinicians

Who Should Read This

  • Medical coders
  • Billing staff
  • Revenue cycle professionals
  • Physician practice managers
  • Surgeons and other physicians

Codes Discussed

Code Ranges Discussed


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