I wanted to share something regarding the ER CPT codes. You're comment regarding using outpatient office visits for a non-ER physician was not incorrect. There is a spin to this...
"To add to what everyone else wrote, he should not be billing the ER cpt codes unless he is the ER physician (because the ER physician has probably already billed them). If consulted, bill the consult codes. If not a consult, I would bill the new pt/est pt codes (99201-99215) or, if patient was admitted, I would bill a subsequent hospital visit (99231-99233)."
I can not take credit for the information below. Another coder (w/ many other credentials) that I follow regularly posted this article on another site. I felt I needed to add this information to this thread.
How to Bill an E/M Service Provided by a Non-Emergency Medicine Provider Who:
a) Did Not End Up Admitting the Patient, and
b) Was Not Consulted
Per CPTÂ®, any physician can bill an ED E/M code, but if two physicians both see a patient in the ED, and one of them is an Emergency Medicine specialist, CPTÂ® (in the summer 1995 and January 2002 CPTÂ® Assistants) says that the EM provider should be the one billing the ED code and the other physician will either bill an admission, consult, or an office/other outpatient visit code. Per the January 2002 CPTÂ® Assistant: “for any single ED patient visit, only one physician can report an ED E/M code.”
So for those payers that give no specific direction that contradicts established CPTÂ® coding instruction, a code from the New/Established Office/Other Outpatient Services range (99201-99215) should be billed as appropriate for a non-ED provider seeing the patient in the ED
1. if the patient was already seen by an ED provider, and
2. if the second provider
a) is not admitting the patient, and
b) was not consulted (usually they were just asked to come manage/treat
Medicare, however (emphasis mine), gives different instruction that contradicts CPT’s direction. They say that the provider contacted by ED to see a patient (but who was not consulted for an opinion and does not admit the patient) should bill the encounter using one of the ED E/M codes:
Medicare Claims Processing Manual
Chapter 12 - Physicians/Nonphysician Practitioners
F. Emergency Department Physician Requests Another Physician to See the Patient in Emergency Department or Office/Outpatient Setting
“If the emergency department physician requests that another physician evaluate a given patient, the other physician should bill a consultation if the criteria for consultation are met. If the criteria for a consultation are not met and the patient is discharged from the Emergency Department or admitted to the hospital by another physician, the physician contacted by the Emergency Department physician should bill an emergency department visit.”
Presumably (but not entirely certain based on Medicare’s manual instruction), the ED physician would still bill an ED series code to Medicare as well if they performed an E/M service prior to the second provider’s service, as Medicare does sometimes allow two providers to bill ED codes for the same patient on the same day. That’s not to say that a particular Medicare carrier doesn’t have an edit that will try to deny the charge on the front end. They may, and an appeal may be necessary to get paid for both services. To improve chances of reimbursement, the documentation should reflect the medical necessity of both encounters.
To be fair on both sides (CPT versus Medicare), I thought it was important to share both views since there could be a carrier that does not follow Medicare's ideology.
- ICD-10 Trainings
- Comprehensive Courses
- CPC (Certified Professional Coder)
- COC (Certified Outpatient Coder)
- CIC (Certified Inpatient Coder) NEW!
- CRC (Certified Risk Adjustment Coder) NEW!
- CPB (Certified Professional Biller)
- CPMA (Certified Professional Medical Auditor)
- CDEO (Certified Documentation Expert – Outpatient) NEW!
- CPPM (Certified Physician Practice Manager)
- CPCO (Certified Professional Compliance Officer)
- VIEW ALL CERTIFICATIONS
Coding / Billing Solutions
- Audit / Compliance Solutions
Job Experience / Apprentice Removal
News / Discussion
- Other Resources
- Book Store
- Log In / Join