Wiki Specialty Provider Eval and Treat in an Emergency Department

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aalley

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I'm hoping someone can clarify this issue or point me in the right direction.
When one of my ENT providers is called to the Emergency Department to evaluate and treat a patient who is not admitted to either in-patient or out-patient status, only seen in Place of Service 23, should I be coding this visit with Emergency Department codes (99282-99285) or out patient codes (99202-99205 or 99212-99215)?
 
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If the patient is in Observation Status. then you would code Initial Hospital Services codes.
If the patient is never even admitted as observation status, then you can code Outpatient Codes or Consult Codes as appropriate.
 
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"When one of my ENT providers is called to the Emergency Department to evaluate and treat a patient who is not admitted to either in-patient or out-patient status, only seen in Place of Service 23, should I be coding this visit with Emergency Department codes (99282-99285) or out patient codes (99202-99205 or 99212-99215)?"

From what I've found, this situation would be coded with ER codes 99282-99285 for Medicare or payors that don't accept consult codes. If the payor is commercial that still accepts consult codes, then 99241-99245.

2013_02_vists.pdf
ED consultation: Patient is not admitted. A patient presents to the ED; general surgery is consulted, but the patient is not admitted to the hospital. If the patient is a Medicare beneficiary, the general surgeon should bill the level of ED code (99281–99285).

Non-Medicare patients are considered outpatients until they are admitted to the hospital, and therefore the outpatient consultation codes are reported (99241–99245).
 
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You would code the ED codes if the disposition of the patient was only ED. If the patient is admitted to observation or IP, things change depending on the scenario. You could code consults if the payer accepts those codes (rare, possibly Work Comp patients). It is possible to see multiple ED codes billed by different providers for the same patient on the same day if they were never admitted.

30.6.11 - Emergency Department Visits (Codes 99281 - 99288)(Rev. 1875, Issued: 12-14-09, Effective: 01-01-10, Implementation: 01-04-10)
A. Use of Emergency Department Codes by Physicians Not Assigned to Emergency Department
Any physician seeing a patient registered in the emergency department may use emergency department visit codes (for services matching the code description). It is not required that the physician be assigned to the emergency department.

F. Emergency Department Physician Requests Another Physician to See the Patient in Emergency Department or Office/Outpatient Setting
If the emergency department physician requests that another physician evaluate a given patient, the other physician should bill an emergency department visit code. If the patient is admitted to the hospital by the second physician performing the evaluation, he or she should bill an initial hospital care code and not an emergency department visit code.

Also read the evaluation and management guidelines at the beginning of the E/M section in CPT and before each section of codes.
 
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I run into broken bone situations in the ED where the treating physicians often call in ortho. In our cases, the ED physician gets the ED code, and ortho gets a new patient outpatient code with POS-22.
 
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