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Emergency E&M w/procedure

  1. Question Emergency E&M w/procedure
    Medical Coding Books
    I am new to emergency billing, I am billing just for the doctor's in this setting. I am billing the e&m w/the procedure (suture's, splints, etc.), because in this setting patients are not considered new or established, so an e&m should be billable, is this correct??? Would I need to amend the modifier 25 when coding both???? Any feedback would be appreciated.
    Thanks

  2. Default
    You should bill codes 99281-99285 for every ER visit and for those that are critical care you would use 99191 and 99292. For splints and sutures you would append a modifier 25 to the E/M code.
    let me know if you have any other questions... I would be happy to help

    JG

  3. Default Sutures in the ER
    Are you using a modifier in the procedure code also? Specifically sutures done in the ER, not knowing if the patient will come back to have them removed. If so, what modifier? And what do you code when a patient comes in just for suture removal that may or may not have been placed in the ER?

    Thanks for any replies.

  4. #4
    Default
    Quote Originally Posted by jonileis View Post
    Are you using a modifier in the procedure code also? Specifically sutures done in the ER, not knowing if the patient will come back to have them removed. If so, what modifier? And what do you code when a patient comes in just for suture removal that may or may not have been placed in the ER?

    Thanks for any replies.

    The modifier 25 is put on the em code..... the cpt code for the sutures (ie 12011) would not have a modifier. When PT just comes to the ER for suture removal v58.32 is used as the dx with what ever level em is worked on the chart. No cpt would be added to for suture removal.

    For splints we use an em with modifier 25 and the cpt for the splint application and a modifier rt/lt depending which side of the body it is on. In our ED we dont use the fracture care codes. we reserve these codes to be use by the specialist the PT sees after they leave the ER.

    I hope I helped,
    Dawn

  5. #5
    Default
    i also do the billing for the physicians in an emergency room and i don't attach modifiers to my procedures and we never have. I know in clinic's we do but not in ER, the only time i use a modifier is for Critical Care with CPR,for Medicare then you have to attach -25 to the critical care in order for them to pay both, but as far as sutures, I & D's.. i don't attach anything and have never had a problem, and i work for a hospital so we have our own private auditors from medicare/medicaid and was never told anything for billing this way.. it may be incorrect but if it is then no one has told us..

  6. #6
    Default
    What about EKG's done in the ER? I always bill a 93005, as told to by our auditing department, and because they are read by a different physician. Also, what other procedures are separately billable, if any, other than sutures/I&D and splinting?

  7. #7
    Default ER consult
    I have a question about a doc being called in to the ER for a consult. Would I code the normal consult code or a ER code? Any suggestions please!

  8. #8
    Default
    Quote Originally Posted by tobester View Post
    I have a question about a doc being called in to the ER for a consult. Would I code the normal consult code or a ER code? Any suggestions please!
    I personally think you should be coding for a consult if your Dr. was called in for a consult. ER codes are kinda reserved for the ER Dr.'s and since the ER Dr. saw this PT on the same day and will be using the ER codes your's would be rejected. Play it safe.

    Any other comments greatly appreciated.

    Dawn, CPC

  9. #9
    Location
    Milwaukee WI
    Posts
    4,466
    Default Outpatient Consult 99241-45
    When our specialists are called to the EDTC by the ER physician for consultation, we bill the outpatient consult codes for that service. If a decision for surgery is made, we append mod -57 or -25 (depending on whether the procedure is major surgery) to the consult code and also bill the procedure as appropriate. All this is subject to documentation, of course.

    F Tessa Bartels, CPC, CPC-E/M

  10. Question E/M modifier to critical care code
    Can you use modifier 25 with a critical care code?

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