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Emergency room cpt codes

  1. Default Emergency room cpt codes
    Exam Training Packages
    If a doctor has admitting privledges to a hospital can they use the Emergency Room CPT codes? 99281, 99282 & etc? or do they have to be employed by the Emergency Room? At a CPC boot camp this weekend, the instructor said the doctor needs to be employed by the ED. Please help in clearing up this issue?

  2. #2
    The physician has to have privileges in the ED in order to treat patients in the ED. Without ED privileges, admitting privileges don't matter.... we have contract physicians who supply coverage for our ED, and we have physicians not part of that contract who also have privileges in the ED, and they bill for their services in the ED. If the physician has been granted privileges by the medical staff to treat patients in the ED, then they would have to use 99281-99291. Hope that helps!

  3. #3
    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 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.

    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.

    If your provider renders care in the ED and then admits the patient to inpatient status on the same DOS, only the initial hospital care service will be reimbursed.

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