I have an ortho doc that sees patients in the ER for evaluation/surgeries. Patient came in for foreign body removal of needle in arm (25248) and doc was able to remove in the ER setting with sedation (not in OR), thus we billed both the procedure and consult as POS 23 for ER. Pt has a medicaid plan, they are stating 25248 is only payable as outpatient/inpatient or at an ASC (21, 22, 24), so they are denying the surgery with POS 23.
My question is, can we bill a surgery performed in the ER as an outpatient if the patient was never admitted and was able to leave the same day?

Thanks so much,
Mallory, CPC