Billing 99283 / Patient not seen by doc?

lakeeyevicky

Contributor
Messages
22
Best answers
0
Good Afternoon Everyone.
I need some input from my fellow coders, particularly those of you in ER coding.
Can a hospital ER charge a level 3 exam, 99283, if the patient left before seeing the doctor? I happen to be that patient.
I was seen by triage nurse, history and vitals were taken then I was sent back out to waiting room. After 1 1/2 hour or so of waiting and no end in sight, I told the person on the front desk I was feeling better and left. I am now being charged (deductible) for a 99283. Is that possible though without any type of Medical decision making?

Vicki Durden, CPC
Manager, Billing and Collections
Lake Eye Associates
 

RebeccaWoodward*

True Blue
Messages
3,126
Location
North Carolina
Best answers
0
99283 requires all 3 components; Hx, exam and mdm.

1-The ancillary staff is allowed to record PFSH and ROS; however, the provider is required to record the HPI. (which doesn't appear was done)

2-Although the nurse took your vitals, this still requires provider interaction (an exam).

3-No MDM

I would dispute this
 
Last edited:

eadun2000

Expert
Messages
487
Best answers
0
Good Afternoon Everyone.
I need some input from my fellow coders, particularly those of you in ER coding.
Can a hospital ER charge a level 3 exam, 99283, if the patient left before seeing the doctor? I happen to be that patient.
I was seen by triage nurse, history and vitals were taken then I was sent back out to waiting room. After 1 1/2 hour or so of waiting and no end in sight, I told the person on the front desk I was feeling better and left. I am now being charged (deductible) for a 99283. Is that possible though without any type of Medical decision making?

Vicki Durden, CPC
Manager, Billing and Collections
Lake Eye Associates
First question needed is this for pro side or facility side? Facility side can charge for a visit without you seeing the doctor. They can charge you (facility side) a minimum of a 99281 for vitals. However, if they ordered an x-ray or blood work then they can code for a 99283. If this is for physician side, I would dispute the charge. If it is facility and nothing was done but vitals, again I would dispute the charge. Hope this helps.
 

Mojo

Expert
Messages
498
Best answers
0
Hi Vicki:

I agree with Eadun2000's assessment; I would assign the same codes with the information given.

Keep us posted on the outcome after you speak to the billing CSR and/or patient advocacy rep.
 
Top