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ED Billing question

  1. #1
    Default ED Billing question
    Medical Coding Books
    I have a claim from the ED, POS 23:

    99053 services provided between 10:00 pm and 8:00 a.m in 24 hour facility
    96374- IV-push

    The IV-push is performed by the nurse who works for the hospital, is the ED doctor allowed to bill it? patient received Dilaudid and Phenergan, we did not get a claim from him for that....

    Is the 99053 allowed?
    Marilyn CPC, CPC-H, CEMC

  2. #2
    Hi Marilyn
    Per CPT under the IV section in the book page 435 of the AMA professional edition “these codes are intended to be reported by the physician in a facility setting”
    As for 99053 this as a status B procedure see below

    Status B
    Codes that are not recognized by OPPS when submitted on an outpatient hospital Part B bill type (12x, 13x, and 14x). Not paid under OPPS.
    • May be paid by intermediaries when submitted on a different bill type, for example, 75x (CORF), but not paid under OPPS.
    • An alternate code that is recognized by OPPS when submitted on an outpatient hospital Part B bill type (12x, 13x, and 14x) may be available
    hope this helps
    Robin Ingalls-Fitzgerald CCS, CPC, FCS, CEMC, CEDC

  3. #3
    Hi Robin,
    I believe it states "these codes are NOT intended to be reported by the physician in the facility setting".

  4. #4
    Default 99053
    So can the ED doctor bill this 99053 along with the 99283? How did you know it was a Status B code?
    Marilyn CPC, CPC-H, CEMC

  5. #5
    Where I work we bill 99053 for the hospitals that require this code (some do not use it, I do not know why) we also bill the IV's only for the nurse because they are usually the ones that do this procedure. However if the Dr by chance did an IV push we would bill his service. You bill the procedure for whoever does the procedure. Not sure if everyone bills the same way but that is how we do it.

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