ED Coding and Reimbursement Alert

Question: Recently Medicare denied our claim for emergency care code 99288. This was our first time using this code. What could we have done wrong?

Vermont Subscriber Answer: Medicare doesn't pay separately for 99288 (Physician direction of emergency medical systems [EMS] emergency care, advanced life support) because it considers payment for the service included in E/M codes 99281-99285 (Emergency department visit for the evaluation and management of a patient, which requires these three key components ...).

Although some private payers accept 99288, check with you carrier before submitting the claim in order to prevent denials.

If the carrier pays for the code, be sure your documentation shows that the ED physician directed emergency care from the hospital using a two-way communication system, according to CPT.

Typically, the physician directs the following medically necessary procedures:

 telemetry of cardiac rhythm
 cardiac and/or pulmonary resuscitation
 endotracheal or esophageal obturator airway intubation
 administration of IV fluids and/or intramuscular, intratracheal or subcutaneous drugs
 electrical conversion of arrhythmia.