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Thread: Charging an E&M okay when referring out?

  1. #1
    Join Date
    Apr 2007

    Default Charging an E&M okay when referring out?

    AAPC: Back to School
    I was wondering if it is appropriate to bill and E&M for someone whom we evaluated and made the determination that the patient needed to be seen in the ER for proper management. We do not participate with hospitals for admits, etc., so if the patients need to be seen at the ER or need admission, we refer to the ER or to a specialist. If we do a brief exam and refer out, is the E&M appropriate? If we do a thorough exam and then refer out, would an E&M be appropriate? I've heard the rule is "No treatment, no charges".

  2. #2


    I'm far from an expert, but if your visit meets all the requirements of an E/M service then bill the visit. Your MD saw the patient, evaluated their condition and made the decision that he/she required immediate medical care that was not not available in your office. Was a Hx taken? Physical exam? Medical decision made?

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