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Charging an E&M when referring to ER

  1. #1
    Question Charging an E&M when referring to ER
    Medical Coding Books
    We are a primary care/urgent care facility withouth hospital priviledges. Is it appropriate to bill an E&M when we did an examination and made the determination to refer to the ER for treatment? I was taught "no treatment means no charges for E&M". Help!! I don't want to throw money away nor do I want to bill inappropriately!!!

  2. Cool Charging an E&M when referring to ER
    I recently took my niece to an urgent care facility (also with no hospital privileges). They determined that she needed to go to an actual emergency room. I questioned whether it was appropriate to have paid a co-pay and it was explained to me that as long as they took a history, performed an examination, did some blood work and formulated a diagnosis, they were going to submit their billing for an E&M. Consequently, my niece received an EOB containing the charges for both the urgent care center AND the emergency room in which both were reimbursed accordingly.

    Hey, if your docs do the work-up and formulate a diagnosis and feel that the patient would best be served in a hospital (E.R.) setting, you should not have to eat the service rendered.

    Hope this helps!

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