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emergency room E&M visit - surgeron practice

  1. Default emergency room E&M visit - surgeron practice
    Medical Coding Books
    Hello,

    I am on day 2 of my employment with a hand surgeron practice. This is a new field for me to code and I've already run into a coding question.

    A doctor saw an ER patient. He charged 99283 which, according to documentation, seems appropriate. However, He also indicates he wishes to charge cpt 99050. I feel that this is incorrect because the code description states that the patient is seen "in the office". My question is--where can I find documentation to back up my theory? Before I go to this physician (as a brand new employee, AND being brand new to surgery coding) I'd like to have documentation supporting my determination that he cannot charge 99050 when he saw this pt. in the ER.

    Thanks to anyone who can help! :-)

  2. #2
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    For one, simply show the doctor the definition of 99050 in CPT, which clearly states "in office". Second, I would be concerned about the ED code - unless your doctor was the only one who saw the patient in the ED. More often then not, the ED doc has already submitted his/her claim and yours will be denied as duplicate, even though the NPI is different. I try to get my docs to use codes other than ED codes if at all possible.

  3. #3
    Location
    Morgantown
    Posts
    44
    Default
    I am kinda of confused. You stated that your doctor seen the patient in the ER? Did the patient go to the ER and seen the ER physician and then ER physician consult your doc to come and see the patient? If so then shouldn't this been a consult code 9924? instead of an ER code?

  4. Default Er e&m's
    Can a hospital ER department charge 99283 and the ER provider, who is contracted with the ER department, charge 99284 for the same patient, same day, same time, same dx?

  5. #5
    Default
    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. If the consulted physician admits the patient to the hospital and the criteria for a consultation are not met, he/she should bill an initial hospital care code.

    http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf

    The above information is from page 60 in the above linked manual. Before that is all the info about consultations.

    Laura, CPC, CEMC

  6. Default
    I agree that if you show the MD the description of code 99050, that should be enough to support the fact that you can't bill for this when the place of service is the ER! I'd be shocked to hear insurance plans pay for that anyway.

    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 would assume it was a consult unless your doctor directed the patient to go to the ER and then he showed up to see him there (which is sort of what I think because he's trying to get away with billing 99050...lol). If that is the case, bill an office/outpt visit code.

    Lisi, CPC

  7. #7
    Default
    http://www.wpsmedicare.com/part_b/policy/phys021.pdf

    Does anyone have documentation stating only one ER E/M can be reported in one day?

    The direction I have been given by WPSMedicare, states multiple providers can bill the ER E/M codes on the same patient on the same day. I have posted the link for the NCD on this issue.

    If someone has something in writing that contradicts this please post it. I will take it back to WPS for further clarification.

    Thanks

    Laura, CPC, CEMC

  8. #8
    Default
    Our clinic is next door to the hospital and our docs go over and see patients in the ER too, if they're called. Our docs will also bill an ER visit (if it's not an admission) and we haven't had problems with it.
    Pam Tienter, CPC, COC, CPC-P, CCS-P, CPMA, CPC-I, AAPC Fellow
    National Advisory Board Member 2018-2021, Region 6 Great Lakes
    Minneapolis AAPC Chapter, Education Officer 2018
    AHIMA ICD-10-CM/PCS Trainer
    AAPC National ICD-10 Trainer

  9. #9
    Location
    North Carolina
    Posts
    3,126
    Default
    Laura,

    You are correct. You validated this in your previous post.

    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. If the consulted physician admits the patient to the hospital and the criteria for a consultation are not met, he/she should bill an initial hospital care code.

  10. #10
    Default
    Thank you both, I appreciate it. I have seen on other posts the same comment, that only ER docs can bill these codes.

    This is the direction we are pointing a lot of providers in and I want to be sure it is correct.

    Thanks!

    Laura, CPC, CEMC

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