# codes for patients who remain in er



## Leigh6189 (Feb 21, 2013)

Hi All
  I need some help!!!
   I bill for Psych Providers who see patients in the emergency room.  They see some patients who remain in the ED  for over 24 hours whoch happens with significant frequency.  Codes 99281-99285 are used for inital only.  Previously we billed the follow up service code 90862 but now the code is no longer a valid code. What would be the codes to use for next day visit in ER?

Thanks!
Lisa


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## mitchellde (Feb 21, 2013)

99281-85 are not initial only they are ER visit levels and can be charged each ER visit.


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## Leigh6189 (Feb 21, 2013)

Thank you so much for the reply.  Yes you are right! Thank you so much!


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## jimbo1231 (Feb 22, 2013)

*Observation*

There might also be an option for Observation codes if the documentation supports them.

Jim S.


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## mitchellde (Feb 22, 2013)

The physician must order admit to observation first.


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## jimbo1231 (Feb 22, 2013)

*Right*

Agreed. Alomg with all of the documentation and medical necessity requirements. but patients who are in the ED and are being treated (not waiting for a bed or tranfer) might qualify. Certainly a suicide risk or out of control psychotic might require Observation. Now getting paid as Observation could be another matter!

Jim


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## Rita Bartholomew (Mar 6, 2013)

We have the same issue in our ED.  Psych pts in our ED for days waiting for a bed in a mental health facility to become available.  They cannot be d/c'd because of suicidal ideation. A provider from Behavioral Health re-evaluates them on a daily basis.  Why wouldn't 90791 be appropriate here?  It can be used in all settings, and can be assigned once a day.


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