ED Coding and Reimbursement Alert

Question: A patient arrives in the ED with suicidal tendencies. Our physician admits the patient to observation status and then calls in the hospital's psychologist for a consultation. The psychologist stays in the ED to monitor the patient, who is at considerable risk. Can our ED physician continue to bill for the observation while the psychologist is on the premises? New Jersey Subscriber Answer: Yes, the ED physician may bill for the observation services (99217-99220 or 99234-99236), and the psychologist may bill for a consultation (99241-99245). The suicidal patient (300.9, Unspecified neurotic disorder) is under the continued medical direction of the ED physician, who will ultimately be responsible for the discharge. The physician, of course, must periodically check in on the patient, and documentation must support the need for ongoing medical care. Coders should also consider that, even though the psychologist is monitoring the patient, he or she is simply observing mental status. The physician remains accountable for the overall care of this individual.