Get Paid for Time Spent in ER When Patient is Admitted on the Same Day
Published on Fri Jan 01, 1999
Pediatricians are often called to the emergency room to see patients. They can spend an extensive amount of time there, and then end up admitting the patient. I am having problems coding a three-hour ER visit, and then theres the history and physical which can require up to another hour, explains Vicky Slaughter, office manager for Eden Pediatrics, a two-pediatrician practice in Eden, NC. Can all of this be billed?
The answer is no, you cant bill for all of these services. You are going to have to use one of the initial hospital care codes (99221, 99222, or 99223) to admit the patient, explains Becky Miller, office manager for Childrens Clinic, a five-pediatrician practice in Tallahassee, FL. Two of our doctors are pediatric endocrinologists, so they have to go to the ER and admit a lot of diabetics, explains Miller.
But you cant bill for the time spent in the ER in addition to the hospital admit. Thats because the initial hospital care code includes any care which is provided elsewhere on that datewhether its the emergency room, the office, or elsewhere. According to CPT: When the patient is admitted to the hospital as an inpatient in the course of an encounter in another site of service (e.g., hospital emergency department, observation status in a hospital, physicians office, nursing facility), all evaluation and management services provided by that physician in conjunction with that admission are considered part of the initial hospital care when performed on the same date as the admission.
However, you canand shouldconsider the work you did in the emergency room when you are determining which level code to use for the admission. Again, from CPT: The inpatient care level of service reported by the admitting physician should include the services related to the admission he/she provided in the other sites of service as well as in the inpatient setting.
Using CPT 99223
There are a variety of situations in which a pediatrician may spend an extensive amount of time with a child in the emergency room. Say a child from out of town is in the ER with new-onset diabetes. The pediatrician spends one hour face-to-face in the ER, knowing that hell have to the admit the child. He should definitely charge a 99223, the office manager says.
Which code you use depends partly on what is wrong with the child, adds Miller. 99223, the third and highest level initial hospital care code, requires a comprehensive history, a comprehensive examination, and medical decision-making of high complexity. The time guideline in CPT is 70 minutes at the bedside and on the patients hospital floor or unit.
All hospital admissions require a comprehensive level of exam and history, so the [...]
