Emergency Department Professional Billing

rmooney1114

Networker
Messages
46
Location
Monson, MA
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Hello, does anyone have any info or resources on the professional side of ED billing/coding. I am wondering what providers can and cant bill for in the ED.
A question came up this week if the providers can bill for vaccine and intramuscular meds given in the ED along with the E/M or if its included in the E/M code, or if it is something the facility bills for?
Any help is appreciated.
Thank you
 

bjland

New
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1
Location
La Mesa, CA
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Hello,

I bill the physician portion of the ER visits and we do not bill for vaccines, medications, etc - only the E/M code and any procedures performed by the physician (ie laceration repairs, manipulation of fractures, etc)

Belinda
 

thomas7331

True Blue
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2,328
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Any CPT codes that have a PC/TC indicator of '5' on the Medicare Physician Fee Schedule are considered 'incident to' codes and are never paid by Medicare on professional claims when the services were performed in a facility. This includes vaccinations, injections, infusions and other procedures which are typically done by ancillary staff under supervision rather than personally performed by the physician. These would typically be billed by the facility on the UB claim as a component of the facility fee.
 

rmooney1114

Networker
Messages
46
Location
Monson, MA
Best answers
0
That is great info. Do you have any references for that information. I just like to provide back-up whenever i educate on a certain topic.
Thank you
 

thomas7331

True Blue
Messages
2,328
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That is great info. Do you have any references for that information. I just like to provide back-up whenever i educate on a certain topic.
Thank you
This information is housed in the Physician Fee Schedule section of the CMS Medicare web site:

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/index.html

Individual code indicator assignments and definitions can be found in the PFS Relative Value Files, linked at the left side of the page.
 
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