ED Coding and Reimbursement Alert

Watch the documentation of minutes carefully when multiple providers are involved with critical care on the same patientWhen two physicians provide care to the same patient in the emergency department, documentation of medical necessity and time will determine if both will get paid. When one provider performs cognitive E/M services and another performs a procedure, payment issues are relatively rare. On the other hand, when two physicians provide E/M services during the same ED visit, watch out for claim scrubber errors and payer denials, says Betty Ann Price, BSN, RN President and CEO of PRCS, Inc. in Palmetto, Florida. Historically, one provider would utilize ED E/M codes (99281-99285) and others would report a consultation code (99241-99245). Reimbursement may be dependent upon a combination of factors under the umbrella of medical necessity.Medicare describes concurrent care as when more than one physician renders services more extensive than consultative services during a period [...]