Wiki Emergency room visits (more than 1 visit within 24 hours)

[ALEX007]

Hello fellow Coders,

If a Patient makes more than one visit per day to the Emergency Dept. (e.g. 2, 3, 4 ED encounters within 24 hours); in what instances would more than one encounter be paid? Are there any guidelines available in reference to such?

Thank you in advance.

 

[1formissy]

You can report the CPT codes 99283 or 99284 more than once during a 24 hour encounter, but only twice. (Facility MUE of 2). However, if the patient is returning multiple times to the ED within 24 hours, CMS will raise their eyebrows because this not common for someone to go back to the ER MORE than once, let alone 3 or 4 times in 24 hours.
As long as you can back up reporting the codes with STRONG documentation that clearly identifies the support than I do not see why it would not be covered.

 

[ALEX007]

you can report the cpt codes 99283 or 99284 more than once during a 24 hour encounter, but only twice. (facility mue of 2). However, if the patient is returning multiple times to the ed within 24 hours, cms will raise their eyebrows because this not common for someone to go back to the er more than once, let alone 3 or 4 times in 24 hours.
As long as you can back up reporting the codes with strong documentation that clearly identifies the support than i do not see why it would not be covered.

thank you very much for your input!!! ???

 

[CodingKing]

Too many visits, they will get suspicious of you prematurely streeting patients without proper treatment/stabilization..