Emergency Department and Medicare

jcarilyn

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Hi all, I'm hoping that someone can help me or direct to where I might find this answer. My company is a payer and very new to the Medicare rules. If the hospital bills (2) 99284 or any EM code for that matter, when I put it in my pricer software, it rejects it. My guess is one of 2 things. 1- both 99284 (or other code) both need the 25 modifier or 2-being as they have to bill us under Medicare rules, they should be billing a G code.

Probably both of them are incorrect, but I'd like to find out where this answer might be so any help you can provide would be great!

Thanks in advance,

Carrie J
 

kbarron

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Ossipee, NH
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ER Dept and MCR

99284 may only be used once on the same day. Do you need to add prolonged services (99354-99355)? I would review the ER note to get the actual codes. Good Luck.
 

kevbshields

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Louisville, KY
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If the hospital is billing, then it may submit as many ER codes as are appropriate (once per encounter). However, Mod 27 is required for facility bills beyond the first encounter that day.

Physicians may only bill for a single E/M per day. Facilities have different standards.
 
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