Attending Physician Consultations in the Emergency Room Attending physicians are frequently called to the Emergency Room to provide specialty specific assessments for patients. The correct category of E&M services to report and bill ER consults is the office consultation codes (99241-45). The written report must include the name of the referring physician. Residents may refer patients for consults. The Emergency Room E&M codes (99281-85) are reserved for the emergency room attending physicians' documentation and billing.   Follow-Up Consults Follow-Up Consults are only billable from an in-patient unit, either a hospital or skilled nursing home. Follow-up consults can only be utilized in two very specific circumstances. The first instance would be to complete an initial in-patient consult that may have required an additional day for finalization. The second occasion would be to assess a patient's status that may have been altered, once the primary physician initiated the medical protocol developed by the specialist. The referring physician must be indicated in the documentation narrative for the specific date of service.   Subsequent hospital visit codes (99231-33) should be reported when a specialist has decided to "follow-up" on a patient's status, or to provide definitive care, without a request from the primary care physician.   Return to Contents | Return to Billing Compliance