Part B Insider - 2003 Issue 6
READER QUESTION: Include Consult in ED Observation
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Article Overview
This reader question and answer addresses how professional services are billed when an emergency department patient is placed in observation status and a surgeon is consulted. It is aimed at coders, billers, and physicians who need a general understanding of outpatient consultation reporting, observation care reporting, and whether modifiers are involved in this situation.
Why This Topic Matters
Articles like this help determine which physician reports which type of outpatient service when observation status is involved, reducing duplicate reporting and helping ensure claims are filed in the appropriate category.
Article Sections
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Question
Introduces the billing scenario involving emergency department observation status and a surgeon consultation. It asks about same-day outpatient consultation reporting and modifier use.
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Answer
Explains the general billing context for outpatient consultation and observation care in this scenario. It also addresses which service category is associated with the consulting physician versus the physician reporting observation care.
What You Will Learn
- How an ED observation scenario affects outpatient consultation billing
- How observation status is discussed in relation to physician reporting
- Whether modifiers are addressed in this type of billing question
- How responsibility for observation care is framed between physicians
Who Should Read This
- Medical coders
- Medical billers
- Physicians
- Revenue cycle staff
- Compliance staff
Codes Discussed
Code Ranges Discussed
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