Editor’s Note: Cutting through the red tape to make certain that you get paid for every dollar you earn has become more difficult than ever, particularly in our current climate of health care reform and ICD-10 transition. The ACEP Coding and Nomenclature Committee has partnered with ACEP Now to provide you with practical, impactful tips to help you navigate through this coding and reimbursement maze.

Question: What do I need to know about billing for a consultation on an in-house emergency?

Answer: When you are called to the floor for a code or other emergency, remember to document each of the procedures performed and the services you provide. You may be able to bill for an initial consult if your expertise is required beyond that of the attending service and the attending or other designee has requested your expertise. Be sure to document the name of the person who requested your consultation. A written order for your consult is required. It is important to know whether the patient status is inpatient or outpatient (eg, observation). Alternatively, more than 30 minutes of time may support critical care when the time claimed is exclusive of separately billable procedures. Otherwise, you may be able to code for subsequent inpatient hospital care, which may be contingent upon whether you are credentialed with admitting privileges. Include in your note participation in CPR, endotracheal intubation, arterial/central venous/intraosseous line insertions, paracentesis, chest tube thoracostomy, etc. Peripheral IV insertion requiring physician skill might be captured with documented medical necessity (eg, multiple unsuccessful attempts by nursing staff).

Brought to you by the ACEP Coding and Nomenclature Committee.

Ms. Price is president and CEO of Professional Reimbursement & Coding Strategies, Inc., and a member of ACEP’s Coding & Nomenclature Advisory Committee.