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ER inpatinet suturing procedure

  1. #1
    Default ER inpatinet suturing procedure
    Medical Coding Books
    A doctor asked me an interesting question about a case and I thought I would get some other opinions prior to answering him:

    A patient is an inpatient. She falls in her hospital room. The oncall doctor for her does not want to come in to the hospital. The ER doctor was too busy to go upstairs to see the patient. The patient was brought down to the ER to have suturing done on her scalp. She was returned to her inpatient room.

    So my question is: Does our doctor have the right to bill an E/M code with the suturing - or since she is already an inpatient, would he just get the suturing procedure?

    Any suggestions??
    Susan Edwards, CPC, CEDC

  2. #2
    Sorry in my title I spelled inpatient wrong, and I cannot edit that part!!
    That is what I get for trying to type fast!!
    Thanks, Sue
    Susan Edwards, CPC, CEDC

  3. #3
    Louisville, KY
    If there is documentation that the E/M service was conducted, code for both. The ER provider, of course, is not limited to the use of 99281-99285. If documentation supports (especially) other management or evaluation for the fall, I can see no reason to preclude coding an E/M service plus the procedure code.

  4. #4
    The ER physician documented that he did the suturing only, I do not believe there is an E/M service documented.
    Susan Edwards, CPC, CEDC

  5. #5
    If it isn't documented, you can't bill it, so the only code the ER physician could bill for is the suturing.

  6. #6
    I appreciate all of the responses, Thank You.

    But I was wondering if anyone can send me a reference site to read more about this problem, now my ER doctor is asking me about the compliance and/or best way to code/bill for this - if it happens again.

    The worse of this case was that we have a hospitalist and this patient's physician does not want the hospitalist to take care of his patients, but when this patient fell, he refused to come to the hospital at that time so that is why the patient was sent back to the ER.

    Thank you...Sue
    P.S. You can email me for more information or just directly.
    Susan Edwards, CPC, CEDC

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