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ER E&M coding help needed!

  1. #1
    Default ER E&M coding help needed!
    Medical Coding Books
    I work for several family practice physicians. One of my docs is asking how to bill this Emergency Room E&M situation. I've researched this on my own and am not coming up with sufficient information.
    Often times the ER Doc calls our doctor in for an admit. Our doc sees the patient in the ER before they are admitted to send them home. The patient has been admitted but not to the floor yet. Sometimes our doc is there and will just see the patient and decide if they need admission. If our doctor deciced to admit the patient, we will bill for the admission. But if our doc decides to send the patient home, how should we code the scenario?
    Any advice and resources would be appreciated!
    Carrie, BS, CPC

  2. #2
    Default
    Quote Originally Posted by cdcpc View Post
    I work for several family practice physicians. One of my docs is asking how to bill this Emergency Room E&M situation. I've researched this on my own and am not coming up with sufficient information.
    Often times the ER Doc calls our doctor in for an admit. Our doc sees the patient in the ER before they are admitted to send them home. The patient has been admitted but not to the floor yet. Sometimes our doc is there and will just see the patient and decide if they need admission. If our doctor deciced to admit the patient, we will bill for the admission. But if our doc decides to send the patient home, how should we code the scenario?
    Any advice and resources would be appreciated!
    You should bill 99211-99215 assuming they are established patients. If new patients, of course 99201-99205. If you look at the descriptions for these, they are office/outpatient codes. Hope that helps~!

  3. #3
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    Milwaukee WI
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    4,466
    Default It depends ...
    I hate to sound like a broken record, but it depends ...

    First, if the patient is admitted you bill an admission code (either inpatient or observation).

    Now, if the patient is sent home after your doctor seems him/her ...
    1) Is the ER doc actually treating the patient, or just calling your physician to come treat? Then your physician might be able to bill the ER codes (if not admited).
    2) Is the ER doc asking for a consultation about something? Your physician may be able to bill the outpatient consult code if he is giving his advice to the ER physician who then sends the patient home.
    3) If the ER doc has evaluated the patient and then calls the patient's PCP to come treat the patient, you are looking at office/outpatient codes (I'm assuming established patient, but I suppose it could be a new patient).

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  4. #4
    Default Thanks
    Thanks to both of you for your input. I agree with both responses (depending on the clinical situation).
    I'm hoping to educate my physician on how to handle these situations. That's hard to do because not every situation ends up with the same answer. Like Tessa said, "it depends...."
    Carrie, BS, CPC

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