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Office E/M for ER visit

  1. #1
    Default Office E/M for ER visit
    Exam Training Packages
    I have been told that an ER visit that doesn't have all 3 elements met (this visit is missing history) can be billed at an Office E/M since it only needs 2 of 3 elements met. The provider is no longer available to query so we cannot get the additional documentation needed to meet the third element.

    Is this true?

  2. #2
    Columbia, MO
    Er visit must be billed using ER codes if all the information was not documented then you cannot bill the encounter.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Thank you Mitchellde!

    Will you direct me to where I can find documentation on this? I would like to have something so if this arises in the future, I will have information directing the proper protocol.


  4. #4
    Columbia, MO
    This is what I have from the CMS manual on ER visits:
    30.6.11 - Emergency Department Visits (Codes 99281 - 99288)
    (Rev.1875, Issued: 12-14-09, Effective: 01-01-10, Implementation: 01-04-10)
    A. Use of Emergency Department Codes by Physicians Not Assigned to Emergency
    Any physician seeing a patient registered in the emergency department may use emergency department visit codes (for services matching the code description). It is not required that the physician be assigned to the emergency department.
    B. Use of Emergency Department Codes In Office
    Emergency department coding is not appropriate if the site of service is an office or outpatient setting or any sight of service other than an emergency department. The emergency department codes should only be used if the patient is seen in the emergency department and the services described by the HCPCS code definition are provided. The emergency department is defined as an organized hospitalbased facility for the provision of unscheduled or episodic services to patients who present for
    immediate medical attention.
    C. Use of Emergency Department Codes to Bill Nonemergency Services
    Services in the emergency department may not be emergencies. However the codes (99281 - 99288) are payable if the described services are provided.
    However, if the physician asks the patient to meet him or her in the emergency department as an alternative to the physician’s office and the patient is not registered as a patient in the emergency department, the physician should bill the appropriate office/outpatient visit codes. Normally a lower level emergency department code would be reported for a nonemergency condition.
    D. Emergency Department or Office/Outpatient Visits on Same Day As Nursing Facility
    Emergency department visit provided on the same day as a comprehensive nursing facility assessment are not paid. Payment for evaluation and management services on the same date provided in sites other than the nursing facility are included in the payment for initial nursing facility care when performed on the same date as the nursing facility admission.
    E. Physician Billing for Emergency Department Services Provided to Patient by Both
    Patient’s Personal Physician and Emergency Department Physician
    If a physician advises his/her own patient to go to an emergency department (ED) of a hospital for care and the physician subsequently is asked by the ED physician to come to the hospital to evaluate the patient and to advise the ED physician as to whether the patient should be admitted to the hospital or be sent home, the physicians should bill as follows:
    ! If the patient is admitted to the hospital by the patient’s personal physician, then the
    patient’s regular physician should bill only the appropriate level of the initial hospital
    care (codes 99221 - 99223) because all evaluation and management services provided by that physician in conjunction with that admission are considered part of the initial
    hospital care when performed on the same date as the admission. The ED physician who
    saw the patient in the emergency department should bill the appropriate level of the ED
    ! If the ED physician, based on the advice of the patient’s personal physician who came to the emergency department to see the patient, sends the patient home, then the ED
    physician should bill the appropriate level of emergency department service. The
    patient’s personal physician should also bill the level of emergency department code that describes the service he or she provided in the emergency department. If the patient’s personal physician does not come to the hospital to see the patient, but only advises the emergency department physician by telephone, then the patient’s personal physician may not bill.
    F. Emergency Department Physician Requests Another Physician to See the Patient in
    Emergency Department or Office/Outpatient Setting
    If the emergency department physician requests that another physician evaluate a given patient, the other physician should bill an emergency department visit code. If the patient is admitted to the hospital by the second physician performing the evaluation, he or she should bill an initial hospital care code and not an emergency department visit code.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Thanks Debra:

    i went looking after I posted the request and found the same information.

    Again, Thank you!

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