Family Practice sent patient to ER

[CMW]

Here in our Family Practice Office there are times we see a patient, then the Doctor makes the decision to send them to the ER or we call 911. We bill an E/M (99213-99214) usually but do we need a modifier on the E/M or should we be down coding to like a 99212?

 

[ehanna]

As long as the doc is not the admitting doc at the hospital you should have no problem billing the appropriate level. I am not aware of any modifier nor do we use one in these cases.

Em

 

[CMW]

Thank you so much for your help!! Much Appriciated for your time!!!

 

[ajgibson]

In the case of Medicare patients, if the patient is admitted within 3 days of an office visit for the same condition, a "PD" modifier is added to the E/M.


Amanda Gibson, CPC-A
Coding Analyst
Memorial Healthcare

 

[cheermom68]

The PD modifier is only used if the physician practice is Wholly owned by the hospital that this patient is admitted to.