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Consults In ER

The question of how to bill for consults in the ER often comes into our “Ask A Consultant” forum.  Which typically goes something like this… our surgeon was called to the Emergency Room to see a patient in consultation. The patient was discharged from the Emergency Room. Can you tell us how to report this?

The Answer is:

First, the correct category of CPT code will be dependent on payor rules. According to the 2014 AMA CPT rules, the service is a consultation and the 99241-99245 codes are reported. Report the consultation code for all payors still recognizing this category of codes.

While, Medicare no longer reimburses the consultation service codes, you would report a CPT code from the Outpatient Codes (99201-99215) will be reported when the patient is seen in consultation in the Emergency Room and discharged to home. The emergency department of the hospital is an outpatient service thus picking from the outpatient codes instead of the inpatient codes. This would also apply if your physician did the consult on a patient in observation as this is also an outpatient department of the hospital. Your surgeon would not report the ED code 99281 – 99285 because the ED physician gets to bill these codes.

Practicing quality medicine while maintaining and managing the bottom line is a balancing act that provider’s face daily. The Physicians Practice S.O.S. Group is committed to and has helped healthcare providers across the country with new practice start ups, IRO needs, streamlining of their A/R and billing process, improving patient flow and providing practice management and compliance solutions. Feel free to call our office to discuss any needs you might have.