ED Coding and Reimbursement Alert

Question: A resident in the ED sees a new patient complaining of heartburn. The resident conducts an expanded problem-focused history and exam and prescribes some antacids. All of this is documented in the resident's progress note. The ED physician, who is working as a "teaching physician," also evaluates the patient, and writes a brief note stating that he examined the patient and was involved in the key or critical aspects of the patient's care. How should I report this encounter?

Minnesota Subscriber

Answer: On the claim, you should report 99282 (Emergency Department visit for the evaluation and management of a patient, which requires these three key components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of low complexity), with 787.1 (Symptoms involving digestive system; heartburn). You should also attach modifier GC (This service has been performed in part by a resident under the direction of a teaching physician) to 99282 to indicate that you are reporting a service under the teaching physician (TP) rules.

Remember: If the TP did not attend the resident's evaluation of the patient and also didn't perform some key/critical portion of the service, as well as reviewing the resident's documentation, then the TP must bill and document the visit as he would in a non-teaching setting.

Good practice: Because the TP's reimbursement now relies on the resident's documentation, the TP should ensure that the resident documents the appropriate history, exam, and medical decision-making elements.