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Need help regarding ER Department E/M codes

  1. #1
    St Louis West Missouri Chapter
    Question Need help regarding ER Department E/M codes
    Medical Coding Books

    I need clarification on would be much appreciated as there is a big board meeting tomorrow night and we have to explain this to our doctors...

    Our practice consists of Neurosurgeons and Neurologists. They see patients in the ER a lot, and want to charge an ER visit (99281-99285) since the patient was seen in the ER.

    Now, it was my understanding from the Medicare Teleconferences, that an ER visit can only be charged if the patient was never admitted as inpatient to the hospital or changed to outpatient status. To summarize, the visit code should be changed to reflect the patient's ultimate status, and the ER visit codes should only be used if the patient was only seen in the ER and never admitted or became an "outpatient."

    Is this correct? I'd like some input from as many coders as possible, because I'd hate for us to give our docs incorrect information...and yes, this Medicare decision to get rid of consults is the reason for the meeting.

    Thanks in advance for any help you can give. You guys are the best!


  2. #2
    I think you are taking the direction 1 step too far.

    If your provider admits from the ER then they would use the admit codes.

    If your provider is called to the ER sees the patient and someone else admits that does not affect your providers coding, they would still use the appropriate outpatient code, in this case the ER codes.

    If your provider is called to the ER after someone else has admitted the patient (they just haven't physically moved them yet) your provider would use the initial inpatient codes since they are inpatient at this time even if they aren't on the floor.

    Hope this helps,

    Laura, CPC, CPMA, CEMC

  3. #3
    Milwaukee WI
    Default ER visits
    The following applies ONLY for patients covered by Medicare!
    A specialist is called to the ER to evaluate a patient.

    If the specialist admits the patient as inpatient use Initial Hospital Visit (9922x).

    If the specialist admits the patient to obesrvation use the Initial Observation code (9921x)

    If the specialist does not admit the patient, bill the ER codes (9928x). This includes the scenario where the patient is admitted by some other physician of a different specialty.

    If the specialist provides critical care use the critical care codes (9929x).

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  4. #4
    St Louis West Missouri Chapter
    Thank you for your responses!

    It's a LOT clearer now!


  5. Default
    Just one quick question regarding these scenarios. Whenever there is an admit on the specialist's part, is the modifier AI also attached. It doesn't matter that provider is a specialist and not, let's say the primary care physician? TIA

    Lila Nagai, CPC

  6. #6
    The admitting provider uses the AI, doesn't matter what specialty they are.

    Laura, CPC, CPMA, CEMC

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