Question ER Wound Re-Check/MDM

Best answers
Hi All,

I have two questions relating to ER's. The first is- If a patient comes in for a uncomplicated wound re-check and is seen by Dr. B but the simple suture repair (12001) was performed by Dr. A, could a ER visit be charged since a different ER provider saw the patient? This leads me to my second question.

On my E/M Audit tool, on Table A, it states New Problem to Examiner. However, I've seen different information regarding this especially for same specialty providers. Since ER's do not have new versus established, would all patient problems be considered new in ER's even if the patient was seen a couple days prior by another ER doctor? Or would the patient complaint be considered established due to the provider's being of the same specialty (ER)?

Thanks for your help!
Winthrop Harbor, IL
Best answers

Yes, the follow-up visit in the ED for the suture removal is billable due to the simple laceration repair having a 0-day global period as both doctors are of the specialty.

Under Table A, it would be new problems with no work-up.

In the ED setting, the new/establish rules does not apply.

Hope this helps.