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Posted By Mary Peabody on 04-17-2020, 12:45:28 in Ob-Gyn
Hello Melanie,

If a patient is seen in ED by the ED physician and the ED physician request a consult by the GYN physician, would you report the consultation CPT code by the GYN? If the payer does not accept the consultation CPT codes, would you report the ED CPT codes for the GYN physician also (99281-99285). If the GYN physician admits the patient, would you report the inpatient admission CPT code (99221) instead of the ED or consult CPT codes even if the patient is seen in the ED? To report the inpatient admission CPT codes, is it required that the GYN physician actually see the patient in the hospital and write an inpatient admission note?
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Posted By Melanie Witt on 04-17-2020, 15:35:14
You would report a consultation code, and this is a Medicare patient, you can follow their rules: " If the ED physician requests that another physician evaluate a given patient, the other physician should bill an emergency department visit code. If the patient is admitted to the hospital by the second physician performing the evaluation, he or she should bill an initial hospital care code and not an emergency department visit code."

If you she is not Medicare, the CPT rule would be to code an outpatient code for the visit. And then per CPT guidelines, all care that day by the same physician is rolled into the final code that describes where the patient ended up. If seen in the ED then admitted to inpatient, you only bill the inpatient code. This information is found in the CPT book on page 16 under the guidelines for initial hospital care. And yes, to bill a hospital admission the patient must be seen by the admitting physician that day and write an admission note.
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