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Thread: Billing Question

  1. #1

    Default Billing Question

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    Is it possible to bill for a patient who comes in to an urgent care or emergency room, gets triaged by the nurse (to include vitals and history), but then leaves without being seen by the physician/provider? My gut says no, but I wanted to get other opinions.

    Thank you!

    Tracy

  2. #2
    Join Date
    Apr 2007
    Location
    Columbia, MO
    Posts
    12,168

    Default

    Yes the facility can generate a bill for the facility charge based on the criteria they have for the facility E&M. There is no physician charge though.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3

    Default

    So if the patient comes into the ED, would 99211 be the correct facility charge? I don't think we can justify 99281, as the patient isn't seen by the provider, but 99211 is for an established patient, which is not considered with ED visits.

    Thanks again,
    Tracy

  4. #4
    Join Date
    Apr 2007
    Location
    Columbia, MO
    Posts
    12,168

    Default

    The facility can charge whatever level is met by their criteria so it could be a 99281 yes for rev center 450 that would be appropriate not a 99211. The facility criteria is very different from physician. The facility criteria is not dependent on the physician but rather the resources expended by the facility, such as the nurse or EMT. You must have a copy of the facility criteria for your facility in order to assign a facility E&M as it must be uniformly applied to all patients.

    Debra A. Mitchell, MSPH, CPC-H

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