tci General Surgery Coding Alert - 2012 Issue 4

Reader Question: Unravel Consult vs. Observation E/M

Question: Our surgeon was called for a consult while the patient was in observation status, and ended up doing an appendectomy. The patient was discharged in under 23 hours. Should we use the observation codes or the consult codes?North Carolina SubscriberAnswer: Assuming that the documentation for your surgeon supports a consultation and the payer is not Medicare (or another payer that no longer accepts consultation codes), codes 99241--99245 (Office consultation for a new or established patient ...) are appropriate for the consult. CPT instruction clarifies that these codes are appropriate for hospital observation.The physician who sent the...

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