Wiki E &m outpatient codes

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I am having a problem with many insurance companies (especially Medi-cal HMO'S). They do not recognize the outpatient codes 99201, 99202 etc. or 99241, 99242 etc. when our General Surgery doctors see them in the ER. They always want us to use the ER codes 99281 etc., even when our doctor is not the first initial attending doctor. Normally, the patient is seen first by the ER doctors because our doctors are not hospital based. I have tried OP codes with both a 22 and 23 place of service. It doesn't seem to matter. I have also had the opposite problem with some of the PPO's. They don't want to pay the ER codes if other ER doctors have billed for the same ER codes on the same day. It always seems to be a guessing game with the insurance companies. Do others have his problem? I am in California.

Thanks,

Dee
 
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I have billed tons of ER encounters in California and have never had a problem using the 99281-99285 with POS 23 for our specialists to see a patient in the ER. You should not use the 99201-99215 codes with POS 22 or 23 for an ER encounter. Check with the payers to determine the exact nature of the denial.

Debra Mitchell, MSPH, CPC-H
 
Thanks, for the answer. I have read several articles from coding magazines that say that outpatient codes can be used in a an outpatient setting such as the ER. They have said that office-based physicians may also use 99201-99204, etc. I think that the use of this policy must vary by carrier. Unfortunately, I have had problems getting the ER codes paid in some cases because of multiple doctors billing the same code for the same day. I am assuming that the carrier did not feel that it was medically necessary for multiple doctors to bill an ER visit on the same day. Oh well!! Thanks for your help!!

Thanks,

Dee
 
Unless my physicians are the first provider to see the patient, they are getting coded as 99201-99215 if they remain outpatient and if it's not a consult. Specialists called by ER docs are normally not consults. ER visits are "typically" for the ER physician aka the first doc to see the patient. I have no problem with the outpatient/office codes billed as outpatient if the POS is 22 or 23.
 
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