You Be the Coder:
Outpatient E/M Codes Are Appropriate for ED
Published on Tue Apr 01, 2003
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: Can we use the 99211-99215 series of codes for emergency department (ED) visits? My insurer denies them, saying that the ED is not an acceptable place of service for these codes. I believe that when the surgeon is called into the ED to assume care of a patient, we should bill using the 99211-99215 series rather than using a consult code. After all, the ED is considered outpatient.
Indiana Subscriber
Answer: Although the emergency department E/M codes (99281-99285) are not limited to the ED physician, an ED physician is most likely to use these codes, and no insurer will pay both the ED physician and the surgeon for 99281-99285 on the same day. (Don't assume, however, that you cannot report an outpatient consultation code when the ED physician calls your surgeon to evaluate a patient. Rather, you evaluate each encounter individually according to the documentation.)
You are correct in reporting an office or other outpatient visit code (99211-99215) when an established patient calls the surgeon, who tells the patient to meet him in the ED. Some insurers may say that you should use the outpatient office visit codes for office visits only, but that's a misinterpretation on their part and shows a disregard for CPT guidelines. Payers may see the place of service listed as an emergency room and immediately deny the claim but you should fight these denials. Write a letter to the insurer appealing the rejection and indicate what the patient's condition was and why he or she required the doctor's specialty care in the ED.
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