Wiki Emergency Dept Coding Question

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GSCoder07

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I code for a Neurologist. He has his own practice but frequently works in the hospital as well. He gets called to the ED for consultations. It's my understanding that if the patient has Medicare, he can bill for an ED visit (99281-99285). Sometimes, the patient isn't discharged on the same day & he's seeing them multiple days in the ED. Of note, the hospital does not list the patient as being in observation, only as being in the ED.
What CPT code(s) can I use for the subsequent times he sees patients in the ED? I've tried using 99212-99215 but the claim denies for place of service (POS 23). Any help would be greatly appreciated!
Thanks in advance!
 
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We bill for multiple specialties that see patients in ED, Obs, Inpt and office. From what you are saying, I would continue to use the ED codes for subsequent visits in the ED. Medicare is very specific about using the ED codes when the patient is being seen in the ED. They say that unless patient is admitted or an order is done to place patient in observation status (as those codes include all "E/M services" provided on that day), you should use the CPT codes for the location the patient was seen.
 
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First of all your doctor is not performing a "Consultation". It's not a consultation unless the three "R"s of a consultation has been met. I don't understand why you would need to bill ED visits for Medicare patients. All insurance companies pay for ED visits, not just Medicare. If you submit an office visit with an ED place of service code, that's an instant denial. I'm surprised your scrubber is not stopping that before it goes out the door.
 
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nrood said:
We bill for multiple specialties that see patients in ED, Obs, Inpt and office. From what you are saying, I would continue to use the ED codes for subsequent visits in the ED. Medicare is very specific about using the ED codes when the patient is being seen in the ED. They say that unless patient is admitted or an order is done to place patient in observation status (as those codes include all "E/M services" provided on that day), you should use the CPT codes for the location the patient was seen.
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Thank you for your reply!
If a patient has a commercial insurance, are we able to still bill ED visits for subsequent visits?
 
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GSCoder07 said:
Thank you for your reply!
If a patient has a commercial insurance, are we able to still bill ED visits for subsequent visits?
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I think Orthocoder meant that you should bill for all insurances, not just Medicare. Like this: I don't understand why you would need to bill ED visits for ONLY Medicare patients.
 
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