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ER admission

  1. Question ER admission
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    Can someone tell me if my ER docs can bill for an ER visit if the patient is admitted through the ER.

  2. #2
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    Quote Originally Posted by elizabethyoung View Post
    Can someone tell me if my ER docs can bill for an ER visit if the patient is admitted through the ER.

    Hi Elizabeth,

    My take is Yes. FYI-If Medicare is involved, then Medicare only pays for the provider who first submits there bill.
    claudia salas

  3. #3
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    North Carolina
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    3,126
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    Quote Originally Posted by claudias View Post
    Hi Elizabeth,

    My take is Yes. FYI-If Medicare is involved, then Medicare only pays for the provider who first submits there bill.
    Not necessarily true...

    I haven't seen this happen often but it can happen.


    F. Emergency Department Physician Requests Another Physician to See the Patient in Emergency Department or Office/Outpatient Setting

    If the emergency department physician requests that another physician evaluate a given patient, the other physician should bill a consultation if the criteria for consultation are met. If the criteria for a consultation are not met and the patient is discharged from the Emergency Department or admitted to the hospital by another physician, the physician contacted by the Emergency Department physician should bill an emergency department visit. If the consulted physician admits the patient to the hospital and the criteria for a consultation are not met, he/she should bill an initial hospital care code.

    30.6.11

    http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf

  4. #4
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    Quote Originally Posted by elizabethyoung View Post
    Can someone tell me if my ER docs can bill for an ER visit if the patient is admitted through the ER.
    At my hospital, we do code both. Keep in mind that we are CAH and may have very different rules applied to our coding here. But I do believe that you can't code both anywhere else, unless, the patient was either admitted by a different physician or a consulting physician.

    Under Emergency Department Services in the CPT book, the last paragraph states "For observation or inpatient care services (including admission and discharge services), see 99234-99236.

    I take that to mean that if it is the same provider in the ER that admits the patient into the hospital, then the provider can only charge for the inpatient admission.

  5. #5
    Location
    Milwaukee WI
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    4,466
    Default Who is the admitting physician?
    Are you saying that your ER doc is the admitting physician? If so (highly unusual), then all services provided would roll into the admission for the initial hospital visit 9922x level of service.

    But maybe I'm not understanding your question correctly.

    F Tessa Bartels, CPC, CEMC

  6. #6
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    I don't know about Elizabeth, but all of our ER patients are admitted through the ER by the same physician (the hospitalist). Not so unusual here. Is that odd?

  7. #7
    Location
    North Carolina
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    3,126
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    Yes...for our area

  8. Default
    Quote Originally Posted by elizabethyoung View Post
    Can someone tell me if my ER docs can bill for an ER visit if the patient is admitted through the ER.
    As long as the ER doctor's have actually gone into the room where the patient is, had a conversation with the patient and or did an exam of some sort, then yes, the doctor (physican billing) can charge for a patient visit. On the same token, if the patient came to the ER because they had a phone conversation with their primary care physician, and their doctor told them to meet them at the ER and is seen only by their own primary care physican and not seen by the ER doctor, then no, the ER doctor can not charge for the ER visit.
    The Hospital Facily can charge for the visit,however, because their nurses triaged the patient, and if any labs or xrays are ordered while the patient is in the ER, before being admitted, the Hospital Facility side can charge the acuity points for all of that to reach their visit level.

    Tracey E.

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