Wiki Type B ED Physician Codes

[golions1986]

Can anyone point me to the guidance related to physician pro-fee codes for Type B emergency room visits. I am doing compliance work for a hospital network in PA. There are several Type B ED facilities that we know we need to use the G codes for. However, there is no clear guidance from CMS as to what codes the docs should use. Would the emergency codes 99281-99285 be correct or would they use 99201-99215?

 

[QuadRider]

99281 - 99285

 

[golions1986]

Can you provide me a source? If I am reading the CFR correctly it looks like office visit codes. I am hoping you are correct, it will make life here much easier for me.

 

[QuadRider]

If you are coding the professional fees in an ER (type irrelevant), you would reference the 99281-99285 series in your CPT book. Hope this helps.

 

[golions1986]

Even though a type B ED is not opened 24 hours a day per CPT guidance?

 

[QuadRider]

Yes. The ER that I have been coding for for 8 yrs (4 yrs facitlity side/4 yrs physician side) here in Calif has been using these codes for many years prior to my employment. They are open from 9am-9pm. The "G Codes" are used for facility billing due to the fact that the ER is not open 24 hrs. This does not apply to the professional fee billing.