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Thread: Family practice Dr. Patient E/R visit

  1. #1
    Join Date
    Apr 2007

    Cool Family practice Dr. Patient E/R visit

    AAPC: Back to School
    I have a scenerio... Patient presents to the E/R, E/R Dr. sees the patient and asks the patient who there primary care physcian is... ER Dr. calls the Prim care physcian in to see patient... What code would the Prim care physcian use?? E/R visit ? or E/M Code? Thanks for any input.. Katie
    Katie Mills, CPC
    Billing Leader
    Hanover Family Practice

  2. #2
    Join Date
    Apr 2007
    Little Rock Arkansas Chapter


    bill an outpt visit code (99212-99215) since the ER is considered outpt, and since it's an established patient for the PCP.

  3. #3

    Default Er visit for PCP

    According to the most recent guidelines, any physician who provides services in the ED may bill and ED visit. Therefore, the PCP should code/bill for an ED visit. Refer to the most recent CMS memorandum that deals with how services previously billed as consultation.

    CMS Medicare Claims Processing Manual Transmittal 1875 and
    MLN Matters from CMS, Number MM6740 dated January 4, 2010

  4. #4

    Default ED visit by primary care provider

    You would bill the appropriate ER visit code 99281-99285.

  5. #5


    The ED Physician will be billing one of the ED codes. If the PCP comes in to see the patient, and admits it would be an initial admit code. If the patient remains in the ED, you could bill an ED code, but chances are if the ED doc bills you may receive a denial. I would monitor that payer and if it denies, an established patient code would work with the setting as POS 22, and state your hospital as the place of service.
    Just a thought. Good luck and put a tickler on it to monitor trends in your denials/payments.

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