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Thread: ER visit vs. Initial care code

  1. #1
    Join Date
    Apr 2007

    Default ER visit vs. Initial care code

    AAPC: Back to School
    We bill for a hospitalist service through our group. A lot of times the hospitalist are seeing the patients in the ER, but they are billing for the initial care inpatient/observation code. Should they be billing with ER evaluation and management codes?

    Thank you,
    Tiffany Fischer, CPC, CEMC

  2. #2
    Join Date
    Apr 2007
    Sioux Falls South Dakota


    If they are admitting the patient to either inpatient or observation, they are using those codes correctly. Even if the encounter started in the ER, when the hospitalist makes the decision to admit the patient, the patient's status changes, the POS will be either IP or OBS (OP), and you bill the correct codes for this new status.

    If, however, they are only seeing them in the ER and the patient is going home, then you are correct, and they need to use the ER or OP codes.

    Hope this helps,
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

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