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ER visit resulting in a scope

  1. #1
    Default ER visit resulting in a scope
    Medical Coding Books
    I have an ENT physician who, several times, has been called to the ER to evaluate a patient, then takes the patient to the scope lab the same date. I'm curious what I can bill for this?
    One example was a young child with a quarter in her esophagus that she had swallowed. He saw her in the ER, then took her to the OR to scope her to remove the quarter. Can he bill for the ER visit (she was also evaluated by the ER doc on call) as well as the scope? Or is the ER visit bundled with the scope?
    Another example was a man who had a dog bite to his face. ER doc evaluates, calls ENT to repair, ENT sees pt in ER, then takes him to the OR to repair the wound. Can I bill for both the visit and the repair?
    I know that it has to be separately identifiable to bill E/M. These patients are not admitted to the hospital. Any help is appreciated.
    Thanks in advance.

  2. #2
    Milwaukee WI
    Default It depends
    For the first scenario, you say the ER calls your ENT doc "to evaluate" ... could the ER doc not be certain if scoping and removal of FB was going to be needed?
    For argument's sake, let's say the child had a really small FB s/he swallowed and ENT was called to the ER to evaluate. Your doc takes a look at the Xrays, examines the child, and feels that the item will pass naturally in a day or so. He lets the ED physician know that no surgical intervention is needed, and the ED physician discharges patient w/ instructions. You'd probably be billing just a consult in that scenario.
    But if, the ENT doc felt that scope w/ removal of FB was warranted, he'd proceed to the scope lab as was done in the case your present. Then you might be billing a consult (with -25 modifier) and the 43215.
    So it's POSSIBLE that your physician performed a consult (I'd need to see the ER notes and what was actually requested, as well as your ENT doc's notes to be certain).

    In the second case you say the ER doc called ENT "to repair." This is NOT a consult, and the basic evaluation service is included in the RVUs for the laceration repair(s).

    Hope this helps.

    F Tessa Bartels, CPC, CPC-E/M

  3. #3
    Thank you for the info. I figured it's driven based on what the ER doc asks for. I've also been told that the doctor's can't bill consults when they see patients in the ER because an ER doc isn't looking for opinion or advice and then taking the patient care back..they are transferring that patient to the doctor who is coming in to consult...therefore, my docs either bill an admit, or an outpatient visit. I think I need more coffee!

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