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ER 99283/Admission 99223

  1. #1
    Default ER 99283/Admission 99223
    Medical Coding Books
    I have a physician who saw a patient in the Emergency and would like to bill a 99283 and then also admitted the patient and would like to bill a 99223. Is this correct?

  2. #2
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    Your provider should only code the admission. Per CPT page 12 of the 2008 Professional edition.

  3. #3
    Default
    Thank you so much! I am new to this and am trying to gather information as questions come along. I will be attending a coding boot camp soon.

  4. #4
    Location
    Loma Linda
    Posts
    50
    Smile ER services but not ER doc
    Can the PCP use 9928X if the ER physician saw the pt? Shouldn't the PCP use a consult code since the ER doc called them in??

    Please clarify the 9928X codes used by PCP's

    Thanks

  5. #5
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    To my knowledge there is nothing that states a PCP can't code 9928X...but if the ED provider has already coded 9928X and the PCP also codes 9928X for the same DOS, one of them will be denied. I would recommend to the PCP that they code depending on what type of visit they provide. If they end up admitting the patient, code an admit. If they treat the condition in the ED and send the patient home, code 99201-99215 (office or other outpatient visit). Coding a consultation would not be appropriate because the ED physician is not asking for an opinion - he/she is transferring care to the PCP.

  6. #6
    Default
    PCP cant bill the codes 99281-99285 these are strictly for the attending in the ER. The PCP will have to use the admission codes (assuming he is the admitting DR) 99221-99223 or if he didnt admit then he would use the 99212-99215 codes.

    I hope this helps.

    Dawn

  7. #7
    Default
    Quote Originally Posted by mlemon View Post
    I have a physician who saw a patient in the Emergency and would like to bill a 99283 and then also admitted the patient and would like to bill a 99223. Is this correct?
    Just a quick addition to my prev answer. The PCP can not bill for the visit and the admission on the same day. He would only use the admission code.

    Sorry,
    Dawn

  8. #8
    Default Pcp Can Not Code 99281-99285 ??
    (Rev. 1, 10-01-03)
    B3-15507
    A. Use of Emergency Department Codes by Physicians Not Assigned to Emergency
    Department
    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.

    From Medicare Carriers Manual
    http://cms.hhs.gov/manuals/downloads/clm104c12.pdf
    page 57

  9. #9
    Default
    Quote Originally Posted by anne1607 View Post
    (Rev. 1, 10-01-03)
    B3-15507
    A. Use of Emergency Department Codes by Physicians Not Assigned to Emergency
    Department
    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.

    From Medicare Carriers Manual
    http://cms.hhs.gov/manuals/downloads/clm104c12.pdf
    page 57
    I so was not taught this way. I need to look into this further. Thanks for the great information.

    Dawn

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