Our physician was called to the ER at the request of the ER physician to evaluate the patient. Our physician went to the ER and provided the consultation services. At the end of the service, the physician decided to take the patient to surgery and admit the patient post operatively. The physician wants to bill the OP consult, but I think he should bill the inpatient admission? Who is right?

You actually have a choice. You may report an OP consult (9924x) or an IP admission (9922x) but not both. According to the AMA, if a physician is called to the ER at the request of the ER physician, the physician may report an outpatient consultation assuming all the requirements of a consultation are met.

Medicare concurs with this advice as per the following excerpt from the Medicare Carrier Manual:

30.6.11 - Emergency Department Visits (Codes 99281- 99288)

F - Emergency Department Physician Requests Another Physician to See the
Patient in Emergency Department or Office/Outpatient Setting

If the emergency department physician requests that another physician evaluate a given patient, the other physician should bill a consultation if the criteria for consultation are met. If the criteria for a consultation are not met and the patient is discharged from the Emergency Department or admitted to the hospital by another physician, the physician contacted by the Emergency Department physician should bill an emergency department visit. If the consulted physician admits the patient to the hospital and the criteria for a consultation are not met, he/she should bill an initial hospital care code.

Based on this, if the criteria for a consultation are met, the physician bills the outpatient consult, 9924X with the ER as the place of service.

If the physician chooses to report an IP admission (9922x) instead of the consult, the physician does not have to re-perform all of the work that was done in the ER. Instead, the physician may combine the work performed during the ER visit with the work performed at the time of admission and report the 9922x series as the service for the day.

Report the E&M service that bests supports the location and work performed by the physician. If it is the consult, report the consultation code, if it is not the consult, then report the hospital admission..but typically the major E&M is the E&M in the ER, thus the consult.

Mary LeGrand, RN, MA, CCS-P
KarenZupko & Associates, Inc.