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Can you bill for an office visit, if the patient is sent to the ED for admission?


Best answers
Hello All. I have a question that I can not seem to find the answer to anywhere and need some clarification.

The scenario " A patient comes into the office to be seen for an issue (acute abdominal pain) they are seen by a provider in the office who thinks they may have appendicitis and so they send the patient to the ED for further work up. The provider who saw the patient is NOT going to be the one admitting them."

Question 1: Can the provider who saw the patient in their office still bill their normal E/M code for the visit prior to sending the patient to the hospital?

On the same subject if a patient went to the ED at 1am this morning for an issue calls the office at 8am & wants to be seen for the same issue.

Question 2: Will the office visit, the patient is requesting on the same day as being seen in the ED, be covered?

I thought that insurance will only pay for the more urgent visit ie: ED visit/hospital stay, in the same day. I can't find where I originally saw this information and now I'm thinking that may not be the case.

Thank you for your help in advance.


True Blue
Columbia, MO
Best answers
if your provider(or other provider in your clinic in the same speciality) had performed both encounters on the same day then you can bill only one. However in both questions your provider was not the same as the one providing the ER or inpatient service so you should be able to bill your visit with no problem.