JAN 16, 2024
Hospital Consult with Same Day Emergent Surgery
One of our doctors provided a hospital consultation before performing emergent surgery on the same day. Knowing not all insurances recognize consult codes, can we bill the exam with the surgery?
Answer:
Effective Jan. 1, 2010, physicians must code hospital inpatient CPT codes 99221-99223 when submitting to Medicare Part B. Some commercial carriers still accept inpatient consultation codes (99251-99255). You will need to append modifier -57 to the appropriate visit code. We recommend billing the exam and surgery on separate claim forms.
Additional guidance on E/M coding can be found at
aao.org/em and in
Fundamentals of Ophthalmic Coding.