Wiki Emergency Room Visit

[sbond]

Can the ER Physician code an ER visit as a 99283 with Dx code 920 and then the ER Facility code the visit as a 99284-25 and 70160 with no modifier? Can the physician and the facility bill different levels? Only the chart face sheet was available- had 'nasal contusion' written on it and D/C time and date. Was advised there wasn't any further medical documentation(no dictation). X ray was done, of nasal bones, 70160-26 with ICD-9 V71.4(from radiologist billing). Any assistance is greatly appreciated, thank you!

 

[mitchellde]

First the facility E&M level does not have to match the physician's. Second The V71.4 would not be used if there were injuries noted such as a contusion, that is a code for conditions not found. Third if the facility has a radiologist that provides the radiology report, then the 26 modifier cannot be billed by any other physician, the facility gets to have the global charge. a wet read or an over read is not chargeable with the 26 modifier. and last the facility would not need to use the 25 modifier as the 70160 is not a status S or T procedure.

 

[sbond]

Thank you much for your reply, you have been most helpful. It would be a great help if the hospital would have the dictation... but they insist that they do not. Thanks again and happy coding!