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ER visit and Initial hospital visit

  1. Default ER visit and Initial hospital visit
    Medical Coding Books
    Can a provider who is working in the ER and also the provider who is admiting the patient charge for both an ER visit and the initial inpatient visit? One of our physicians works the ER under a hospital contract but then works for our office which is seperate from the hospital.

    Thanks for any help that you may be able to give.

  2. #2
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    Quote Originally Posted by JCampbell View Post
    Can a provider who is working in the ER and also the provider who is admiting the patient charge for both an ER visit and the initial inpatient visit? One of our physicians works the ER under a hospital contract but then works for our office which is seperate from the hospital.

    Thanks for any help that you may be able to give.
    CPT Guidelines for initial hospital care say:
    " When a patient is admitted to the hospital from another site of service (eg, hospital emergency dept, etc.), all E/M services provided by that physician in conjunction with that admission are considered part of the initial hospital care when performed on the same date as the admission. The inpatient level of service reported by the admitting physician should include the services provided in other sites of service, as well as in the inpatient setting."

    If the same doctor that admitted also saw the patient in the ED, then you only bill the initial hospital care code (with modifier AI) - you adjust the level to accomodate for the work done in the ED. If one physician saw the patient in the ED, and a different physician admitted the patient, each doctor bills for the work that they did independently. Hope that helps!

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