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Billing 99283 / Patient not seen by doc?

  1. #1
    Default Billing 99283 / Patient not seen by doc?
    Medical Coding Books
    Good Afternoon Everyone.
    I need some input from my fellow coders, particularly those of you in ER coding.
    Can a hospital ER charge a level 3 exam, 99283, if the patient left before seeing the doctor? I happen to be that patient.
    I was seen by triage nurse, history and vitals were taken then I was sent back out to waiting room. After 1 1/2 hour or so of waiting and no end in sight, I told the person on the front desk I was feeling better and left. I am now being charged (deductible) for a 99283. Is that possible though without any type of Medical decision making?

    Vicki Durden, CPC
    Manager, Billing and Collections
    Lake Eye Associates

  2. #2
    Location
    North Carolina
    Posts
    3,126
    Default
    99283 requires all 3 components; Hx, exam and mdm.

    1-The ancillary staff is allowed to record PFSH and ROS; however, the provider is required to record the HPI. (which doesn't appear was done)

    2-Although the nurse took your vitals, this still requires provider interaction (an exam).

    3-No MDM

    I would dispute this
    Last edited by RebeccaWoodward*; 07-13-2011 at 03:20 PM. Reason: spelling
    Rebecca CPC, CPMA, CEMC




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  3. Default
    Quote Originally Posted by lakeeyevicky View Post
    Good Afternoon Everyone.
    I need some input from my fellow coders, particularly those of you in ER coding.
    Can a hospital ER charge a level 3 exam, 99283, if the patient left before seeing the doctor? I happen to be that patient.
    I was seen by triage nurse, history and vitals were taken then I was sent back out to waiting room. After 1 1/2 hour or so of waiting and no end in sight, I told the person on the front desk I was feeling better and left. I am now being charged (deductible) for a 99283. Is that possible though without any type of Medical decision making?

    Vicki Durden, CPC
    Manager, Billing and Collections
    Lake Eye Associates
    First question needed is this for pro side or facility side? Facility side can charge for a visit without you seeing the doctor. They can charge you (facility side) a minimum of a 99281 for vitals. However, if they ordered an x-ray or blood work then they can code for a 99283. If this is for physician side, I would dispute the charge. If it is facility and nothing was done but vitals, again I would dispute the charge. Hope this helps.

  4. #4
    Default
    Hi Vicki:

    I agree with Eadun2000's assessment; I would assign the same codes with the information given.

    Keep us posted on the outcome after you speak to the billing CSR and/or patient advocacy rep.

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