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Non-E.R.docs using the E.R. Codes

  1. #1
    Default Non-E.R.docs using the E.R. Codes
    Exam Training Packages
    Can someone help resolve a debate going on in my office?

    If a doctor is called to treat a patient of his in the E.R. (not as a consultant...as a regular doctor who is known to the patient)

    Can the doctor use the Emergency Room E&M codes?

    I've been told by coders at my job that the codes should only be used by the E.R. doctors specifically.
    That instead we should be usining the regular "Est.office/outpatient visit" codes.

    However,,,,my teacher (I'm still a student member here) instructed us that the E.R. E&M codes may be used by other doctors....NOT just for the docs' who work the Emergency Room.

    What is the verdict here?
    Are the 99281-99285 codes the exclusive domain of the Emergency room doctors?

    Thank you!

  2. #2
    Location
    Seacoast- Dover New Hampshire
    Posts
    609
    Default ER
    If the ER doc called the PCP in to look at the pt you may use 9921_. If the pt saw the PCP and not the ER doc, I would use the ER codes.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  3. #3
    Location
    Louisville, KY
    Posts
    1,101
    Default
    Any providers may use the 99281-99285 series. However, only a single provider can report these per DOS.

    I hope this helps.

  4. #4
    Location
    Milwaukee WI
    Posts
    4,466
    Default CAN use ER codes if ER doc doesn't
    The key would be whether the ER doc is billing any visit on the same date of service.

    Our ER docs will write on their document sheet something along the lines of: "Ortho only" (as an example) to indicate that THEY did not see the patient for a billable service, but rather, called in another service to see the child.

    This lets the coder know not to code any visit to the ER doc and to allow the ER codes to be used by the physician who actually provided the service.

    F Tessa Bartels, CPC, CEMC

  5. #5
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    your teacher is correct. (as well as kbarron, kevbshields and Tessa too!)
    Donna, CPC, CPC-H

  6. Default
    Any physician can utilize the ED codes, but as stated by kevb, the ED codes can only be billed once per DOS; what I have experienced in the past and have since resolved is that when our physicians were called to the ED and we were using ED codes, a large percentage of our claims w/b denied because the hospitals had ED attending or hospitalists that would bill the ED codes as well. Because our physicians covered multiple hospitals, it is impossible to know what the ED Depts are billing, therefore, we started utilizing the consultation codes. Coding for ED is subjective, it's different for each practice, we are ENT specialty, regardless if the patient is known to us, we are called to the ED for "consultation" and that is what is billed. But again, each situation is reviewed and individually determined as to what is appropriate. If you review the guidelines, codes 99241 - 99245 can be performed in the emergency dept.

    Jennifer, CPC
    ENT

  7. #7
    Location
    Seacoast- Dover New Hampshire
    Posts
    609
    Default
    Sometimes the PCP will tell the pt to meet him in the ER. The PCP is allowed a room in the ER to examine the pt. The pt will be registered by that staff as an appt with DR B. Then the approiate code will be used.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  8. #8
    Default May depend on location
    Hello all,
    I just wanted to let you know that the Medicare contractor for New England states that if the ED doc calls in a physician and it's not a consult or admission, the physician that's called in should also use the ED codes. This was just issued 03/09 so it's pretty up to date. You may want to check with your local carrier. Here's the link to what we use (pg 16-17)

    http://www.medicarenhic.com/provider...ng%20Guide.pdf

    UPDATE-Here's CMS's manual (pg 59) updated 12/08:
    http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf

    Hope this helps!
    Sue
    Last edited by SUEV; 04-08-2009 at 07:41 AM.

  9. #9
    Location
    Seacoast- Dover New Hampshire
    Posts
    609
    Default
    Thank you for the updated information
    Karen Barron, CPC
    Hampton New Hampshire Chapter

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