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Can we get paid for ED to ED Transfer?

  1. #1
    Default Can we get paid for ED to ED Transfer?
    Medical Coding Books
    I have a ER doc with this question?

    The patient in question was a rescue one from Hospital A by helicopter that had to stop in the ED awaiting cath lab (it was 3 in the morning and they weren't ready and the patient got worse on the flight). The documentation was done in a short time and arguably any money the ED gets for this patient is good -- he turned out to be an ED to ED transfer so I doubt we will get any money.
    My interest was in doing what was best for the patient as far as his heart care and not in getting paid for it. I feel/felt that he got way more documentation then he needed since he was never supposed to stop in the ED! How about some guidelines on cases like this where the patient was not supposed to stop in the ED and has to for good pt care?

    I feel they should get paid for the high level of care/risk. If 30 minutes of CC time doesn't apply then E/M for sure. Any suggestions?

  2. #2
    Milwaukee WI
    Default Code for the service provided
    I understand your hesitancy in that the patient "wasn't supposed to come to the ED."

    Code what the documentation supports by your ED physician. If it's critical care, then you would use 99291-92 (depending on time). If not critical care then use appropriate ER visit codes.

    You SHOULD get paid for the service provided. It seems from your brief description that this was clearly medically necessary care.

    Hope that helps. Good luck.

    F Tessa Bartels, CPC, CEMC

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