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Thread: ER Visit Codes

  1. #1
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    Default ER Visit Codes

    When you are seen in the ER the hospital will bill for the 9928*. So what does the physician that seen you bill for?
    Herbie W Lorona Jr., CPC, CPC-H
    hlorona@up2parmedicalclinic.com

  2. #2
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    The hospital bills a facility fee (9928x) and the physician charges for a professional fee (9928x). There is both a professional and facility component to all ER visits, depending on who you are coding for.

  3. #3
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    So they both will bill the same code?
    Herbie W Lorona Jr., CPC, CPC-H
    hlorona@up2parmedicalclinic.com

  4. #4
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    If you are talking about technical and professional components it doesn't apply for these codes from what I see!
    Herbie W Lorona Jr., CPC, CPC-H
    hlorona@up2parmedicalclinic.com

  5. #5
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    Default ER visit codes

    The facility is allowed to charge for the visits as well as the physicians. The facility charges are for the room/bed, the supplies used, the instruments used, and any procedures done (this is where the TC/26 comes in), etc. The physician is also allowed to charge for seeing the patient, they use the facility (so the overhead belongs to the ER/hospital) and they will bill according to their documentation. They may not always have the same CPT code, but it's generally close because the more traumatized/sick the patient, but more supplies/instruments/parts of the facility, will be utilized.
    Does this make sense? Sometimes I have trouble saying what I'm trying to get across. I lose something between my brain and my fingers.
    Anna Weaver, CPC, CPMA, CEMC
    Associate Auditor

  6. #6
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    Yes it does make sense but when I am looking up the fee schedules for that online it does not show that code has a professional or technical component with it.
    Herbie W Lorona Jr., CPC, CPC-H
    hlorona@up2parmedicalclinic.com

  7. #7
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    The visit levels do not have a professional and technical component. This came about in 200 with APCs. Facilities had to have a way to account for the utilization of the facility resources that are consumed in a patient visit. Think of anything that cannot be accounted for with a CPT or HCPC II code. Otherwise it cannot be billed. So they made available for facility use the E&M codes. The facility uses the same codes but they mean different things to the facility. That is why you do not see professional and technical components. Also FYI the facility now has HCPC II codes to use for the ER visit levels and they still use the 992xx codes for clinic visits.

    Debra A. Mitchell, MSPH, CPC-H

  8. #8
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    So when the ER is billing you for that code it is correct? It just seemed weird when I received a bill from the er physician and from the hospital and they both are charging me alot for the same code.
    Herbie W Lorona Jr., CPC, CPC-H
    hlorona@up2parmedicalclinic.com

  9. #9

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    both professional and facility use 99281-99285, along with cc codes 99291-99292. One is for the physician and the other is for the facility... that is ER coding.

  10. #10
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    Quote Originally Posted by Anna Weaver View Post
    The facility is allowed to charge for the visits as well as the physicians. The facility charges are for the room/bed, the supplies used, the instruments used, and any procedures done (this is where the TC/26 comes in), etc. The physician is also allowed to charge for seeing the patient, they use the facility (so the overhead belongs to the ER/hospital) and they will bill according to their documentation. They may not always have the same CPT code, but it's generally close because the more traumatized/sick the patient, but more supplies/instruments/parts of the facility, will be utilized.
    Does this make sense? Sometimes I have trouble saying what I'm trying to get across. I lose something between my brain and my fingers.
    Is the physician and the hospital both using POS 23.

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