Wiki 12 hour emergency room billing

[mwright58]

I currently have some ER docs that are manning a 12 hour only ER. They are concerned as to what I am telling them on the billing codes to use. Being that they are a Type B ER and are only open for 12 hours it is my understanding they should use the 99211 to 99215 and 99201 to 99205 codes with a place of service 22 or 23. Clarification on the POS would be appreciated as well. They think they should be billing the ER codes 99281 to 99285 but it clearly states in CPT that these codes are to be used in a 24 hour facility. Also they need to understand that CPT states that there is no distinction between new and established patients in the ER and that they may report any new or established patient who seeks treatment in the ER this way.

Can anyone clarify Thanks in advance for any help you may provide me.

 

[alwaysunny84]

I Concur

While I have not done ED billing and don't profess to have any experience in this area, I did go out and look at the guidelines just now and from what I'm reading, you are spot on. My head is questioning the urgent care facilities and yet when I think through the processes they encounter, true emergent cases are sent on to the ER at that time. I'll be interested in seeing other thoughts on this.
Diane

 

[mwright58]

thanks for the response. It is classified as a true 12 hour ER not Urgent care so we will use 23 POS for now and see how this goes.

Thanks