emergency room coding

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Columbus,Ohio
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I have a question. I am a CPC but have never done ER billing before. I recently had my daughter in the emergency room and we saw a resident and then a fellow. We never saw the attending physician. I know from being a coder that a resident can't bill and neither can the fellow but can the attending bill for a service in the ER if they never saw the patient.
 

satencio

New
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1
Location
Evans, CO
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I am an emergency room coder, so the answer to your question is- it depends on your insurance. If you have Medicare, Medicaid or Tricare the physician has to see you in order to bill the physician part. If you have any other insurance or are self pay then the physician can review your chart and sign off on it and the exam can be billed under the physician.
 

mitchellde

True Blue
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13,538
Location
Columbia, MO
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The facility can charge even if the physician did not see the patient at all. Even if it was only a nurse triage encounter the facility can charge for the encounter. I would not say that other insurances allow the physician to sign off on the bill and charge as that is incident to billing, you have to have a policy in writing from the payer indicating they understand that the physician has not examined the patient. However incident to billing has never applied to the facility setting. Residents need the physician to also examine the patient and indicate that they have also examined the patient, However I thought fellows could bill for their services, but maybe that is state by state.
 
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