Wiki Billing for Two Providers in the same ER

[jzaato2010]

Patient was seen in ER for broken arm. One provider did the evaluation of the situation, the other provider performed the reduction/manipulation. Do the 99284 and 25605 get billed on separate claims since they were done by two providers?

ALSO

We are a small CAH and a patient was seen in our ER with a broken arm. Conscious sedation was used to perform reduction with manipulation (25605). I have seen documentation that conscious sedation is now separately billable. When I access NCCI edits it shows that there is 0 modifiers that will allow 25605 to be billed with 99156/99157. I am not finding any other documentation to tell me how to handle this.



Thank You,
Jzaato

 

[Davieda Skobel]

Billing for two providers in the same ER

Two providers providing different care in the ER is a challenge for sure.
Most insurances only pay one provider per day especially if they are in the same group and same POS.
You may have to give both charges to one of the providers which in the long run if they are a group practice it shouldn't matter unless you pay your providers by the amount they bill or collect.

in a group practice even though two different providers provided the care it usually is ok the bill with one NPI. check with their insurance to see if they have a rule regarding more than one visit per day.
If the Dr that set the arm was not a part of the ER group then he /she can bill separately .


Your second question regarding the conscious sedation is easier to answer. The main question is who provided the sedation? There are different codes regarding if the SAME physician who provided the therapeutic services provided the conscious sedation or if a totally DIFFERENT provider provided the conscious sedation.

Always check your documentation to be sure.

99151 thru 99153 are for the SAME provider with the assistance of an" independently trained healthcare professional"
99155 thru 99157 are for DIFFERENT providers.

Always check the age of the patient also because that also makes a difference.
Always check the length of time the procedure lasted also.

I use a Coders' Desk Reference for Procedures to clarify the procedures.

This is just my opinion so you always have to investigate yourself to be sure.
We also know the rules in coding and billing constantly change.

Good Luck
Davieda Skobel CLPN, CPC