Wiki Emergency E&M w/procedure

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Bemcg1957

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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
 
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
 
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.
 
jonileis said:
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.
Click to expand...


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
 
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..
 
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?
 
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!
 
tobester said:
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!
Click to expand...

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. :rolleyes:

Dawn, CPC
 
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
 
Mod 25 for any E/M codes

Carol asks:
Can you use modifier 25 with a critical care code?


The answer is YES. Modifier -25 is used on ANY E/M code which is separately identifiable when done on the same day as a procedure or other service (e.g. CPR & 99291). Just be sure that the procedure/service is not bundled into the critical care code.

F Tessa Bartels, CPC, CPC-E/M
 
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