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In the CPT explanation for this code set does "decision to see the patient within 24 hours or next available urgent visit appointment" apply only to the provider on the phone call?
Example: Phone call between a patient and provider results in a decision to send the patient to the ER, can this code be billed (assuming the provider contacted is not seeing the patient at the ER)?
 
Is admission anticipated?

Are you sending the patient to the ER with the expectation that they are going to be admitted? Or are you sending them to the ER for an acute problem that will be treated there?

If you think they are going to be admitted but you won't see them until the next day ... then NO, I wouldn't use these codes.

If you're sending them to the ER for treatment, then technically you could use the codes, but do you really want to? (example: I sliced my thumb open and called my PMD. I told him I was pretty sure I didn't need sutures but haven't had a tetanus shot in quite a while. His response was to send me to the ER because IF I needed sutures he'd have to send me there anyway. And, No, he didn't charge me for the phone call.)

Just so you know, our practice does NOT currently use these codes.

F Tessa Bartels, CPC, CEMC
 
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