Primary Care Coding Alert

Like most coders, you probably assume that a family physician and an emergency physician cannot use emergency department (ED) services codes (99281-99285) for care of the same patient on the same day and both get paid by Medicare. But, if you take a closer look at the Medicare Carriers Manual (MCM), you'll be happy to discover you're wrong. The MCM contains a very clear directive that many coders are unaware of. It specifically instructs carriers to advise physicians that they should use ED codes when they provide care to a patient in the ED but do not admit the patient to the hospital. Medicare says primary-care physicians (PCPs) should use the ED codes even when the ED physician also uses those codes.

FPcoders who follow this instruction say Medicare does reimburse them. Barbara Holley, CPC, CCSP, a coding specialist at the Stuart, Fla.-based Martin Memorial Medical Group, says she is not aware of any denials by Medicare during the more than two years her office has coded ED visits according to this directive. Offices that have been denied when using ED codes properly for FPservices should copy the appropriate section of the MCM and send it to the carrier with their claims. Medicare Spells It Out The relevant part of MCM, Section 15507, says, "Any physician seeing a patient registered in the emergency department may use these codes." Section F-2 specifically addresses how to code when a patient's personal physician sees the patient in addition to the ED physician but does not admit the patient: If the ED physician, based on the advice of the patient's personal physician who came to the emergency department to see the patient, sends the patient home, then the ED physician should bill the appropriate level of emergency department service. The patient's personal physician should also bill the level of emergency department code that describes the service he or she provided in the emergency department. The patient's personal physician would not bill a consultation because he or she is not providing information to the emergency department physician for his or her use in treating the patient. If the patient's personal physician does not come to the hospital to see the patient, but only advises the emergency department physician by telephone, then the patient's personal physician may not bill. Note: For when to bill a consultation code under these circumstances, see companion article in article 2. Use Outpatient E/M Codes for some Privates Although Medicare says an ED code not an outpatient E/M code should be used when the FPsees a patient in the emergency department, some private carriers may balk at paying an ED code for both an FPand the ED physician. "FPs should know they [...]