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ER visits for ortho Dr

  1. Default ER visits for ortho Dr
    Medical Coding Books
    HI All

    I hope someone can help. Our ortho Dr. are called to the ED by the ED Dr. should we bill with ED codes 99281-99285 if the location is the ED or out-pt office codes? Our Dr. are not employed by the hospital they came from an out side group.

    Any advice will be appreciated.

    Thank you.

  2. #2
    Location
    Daytona Beach, FL
    Posts
    752
    Default
    Assuming the Ortho is called in to do a consult in the ED, if the patient is Medicare, the ortho would bill using the ED codes 99281-85. If they are not Medicare and the carrier still recognizes the consult codes, you would bill with the Outpatient Consult code.

    This is how I understand what Medicare has stated.

    Any other thoughts?

    Jodi Dibble, CPC

  3. #3
    Location
    Milwaukee WI
    Posts
    4,466
    Default Unless ...
    Jodi is 100% correct ... UNLESS ...

    If the orthopaedist admits the patient for surgery then you would bill the appropriate Inpatient Initial Visit or Observation Admission code.

    F Tessa Bartels, CPC, CEMC

  4. #4
    Location
    Nashville AAPC Chapter
    Posts
    937
    Default
    I would only add, that if the ortho does a procedure in the ED such as a reduction or splint application, they also must use the ED E/M codes as they have taken over the care of the problem.

    The ED physician has no intention if following up on this patient's problem, the ortho MD is.

  5. #5
    Default
    Would you still advise the ED physician to also code the 99281-99285 range if the Ortho MD will too?

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