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ER Physician Billing

  1. Post ER Physician Billing
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    Can an emergency room physician that does there own billing code for 94760 in addition to the emergency room E/M 99281-99285?

    Can they also bill for x-ray?

    What I have found in CPT is that these are included in Critial Care E/M codes but are not listed under Emergency Department or Office or Other Outpatient Services E/M codes.

    Hello- someone out there must code for Emergency Room Physicians
    Last edited by tlabarg; 09-03-2009 at 08:03 AM. Reason: No reply

  2. Default You can, but....
    Pulse Ox is coded fairly rarely these days by ED docs. Government plans won't pay for a professional component of a 94760 as well as many other payors. But a few payors still pay so it is coded here and there. But remember you uare coding for the pc of the pulse ox with a 26 modifier. Also simply a value( 98% on room air) isn't enough. You are coding for the physician interp.
    X-Rays are also coded less than the used to be by EDs but more often than Pulse Ox's and other labs. In the 90s Medicare established a guidline that basically stated the the government would only pay for one x-Ray Interp in the ED. Before that they paid for both the ED doc and Radiologist. Basically what Medicare states is that they will pay for the Interp that most directly ties into diagnosis and treatment of the patient. An argument can be made that this is billible by ED docs when the Radilogist is fast asleep . But this whole issue has often become a political football in many hospitals also because Medicare will typically pay for the first interp they receive which can result in many denials for the Radiologist.
    So I would check with managment on the situation with the Radilogists. But an argument can be made to administration that ED off hour reads should be billed by the ED docs.
    Also Ultra-Sounds can clearly be billed if your ED docs are certified to do that and of course there is proper documentation.

    Jim Strafford CEDC MCS-P

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