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EM coding - how would you code

  1. #1
    Red face EM coding - how would you code
    Medical Coding Books
    If a patient is seen after hours, then sent to the hospital for tests, and then seen again for follow up of tests in the same day by the same physician in an office setting, how would you code this? We are a family practice office. Medicare Part B will not reimburse 99050 in South Carolina. Would you bill the EM code only?

    Thanks, Ann

  2. #2
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    Quote Originally Posted by Annacate View Post
    If a patient is seen after hours, then sent to the hospital for tests, and then seen again for follow up of tests in the same day by the same physician in an office setting, how would you code this? We are a family practice office. Medicare Part B will not reimburse 99050 in South Carolina. Would you bill the EM code only?

    Thanks, Ann
    I'd probably bill a high level E/M, with a 22 modifier on it, if the documentation's good enough. Be ready to send records if you do that - they will ask for them. You might also be able to add a prolonged services code (Can't remember the CPT - but it's at the end of E/M, I think)...But once again, your notes have to demonstrate the service, which means start/stop times, and plenty of notes detailing why all of the work was necessary at the time, must be documented in the record. Hope that helps!

  3. #3
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    Thanks a lot. Ann

  4. #4
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    Modifier -22 is appended to procedure codes and should not be appended to an E/M service. Combine the documentation of both visits to determine the E/M code and if a prolonged services code is warranted.

    The add-on codes for prolonged services code will require documentation of 30 minutes or more above and beyond the assigned E/M level time. Prolonged services codes can also be used on lower level E/M codes.

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