An ambulance from your hospital responds to a report of an automobile accident. The
ED physician answers the EMS staffs call for medical direction. In addition to getting information on the number of injured who will be transported and the seriousness of the injuries, the physician provides clinical guidance to the EMS personnel, instructing them on the administration of medications and advanced resuscitation measures. Can the physician bill for the supervisory services via radio, i.e., the medical direction of ambulance and EMS personnel?
According to CPT, this is a recognized service reportable with its own code99288 (physician direction of emergency medical systems [EMS] emergency care, advanced life support). However, because this service does not involve actual face-to-face contact with the patient, Medicare does not acknowledge this as a physician service and will not pay for it, says David McKenzie, physician reimbursement manager for the Dallas, TX-based American College of Emergency Physicians (ACEP). The Health Care Financing Administration [HCFA] has assigned no physician relative value units to this code, he relates.
Dont Report to Medicare
Language contained in the Health Insurance Portability and Accountability Act of 1996 (HIPAA) has been interpreted by some health information experts to indicate that reporting a code to Medicarethat HCFA specifically states it will not coveris a form of fraud, says McKenzie. Although not everyone agrees with that interpretation, he recommends against reporting the code to Medicare.
This leaves the question of whether or not to bill the code to private payers.
It is certainly providing a CPT-recognized medical service to the patient and incurring medical/legal liability, both of which, I think, deserve to be compensated, McKenzie notes.
Practical/Ethical Dilemma
However, many ED groupsfor both practical and ethical reasonscode professional services the same way for all payers. One, it involves much more record keeping and paperwork to keep up with specific payer coverage policies. Two, many groups oppose coding based on payment policy and not strictly on the service provided.
I have always been pretty strongly of the opinion that, other than for payers whose payment policies you are legally obligated to follow, you shouldnt tailor your bill based on what you know the payer is going to pay, McKenzie states.
Of course, this perspective requires recognizing that there are certain codes that will be covered by some private payers and not by others. Groups ordinarily can report the same codes to all payers, accepting payment from the ones that cover it, and writing off as debt the charges for patients covered by other plans and pursuing collection for the ones that dont.
However, with HIPAA, physicians are between a rock and a hard place with Medicare.
You have the same scenario with the administration [...]
