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Question: If a patient comes in to the emergency department (ED), is seen by the ED physician, and the physician requests a surgical consult, usually the surgeon bills his professional component. How should the hospital bill for his facility component?

Iowa Subscriber

Answer: The facility should factor the consult into its criteria for determining the ED evaluation and management (E/M) level of service. You have five levels to choose from, and which one you pick depends on the amount of resources expended on the patient. Codes for levels one (99281) and two (99282) map to APC 610, level three (99283) to APC 611, and levels four (99284) and five (99285) to APC 612. Don't simply opt for whatever level the physicians choose, because they may have used more or less resources than your facility. Instead, decide according to the guidelines your hospital has set up.
 
If the surgeon performs a surgical procedure during the visit, you may bill the CPT code for the surgery in addition to the E/M level when properly documented.

  Reader questions reviewed by Sarah Goodman, MBA, CPC-H, CCP, president of SLG Inc. Consulting in Raleigh, N.C.