# ER billing confuison...



## hnroberts (Apr 11, 2012)

Alright Coders... 
I work in Hem/Onc and have no specific knowledge of how ED coding works so I'm relying on your expertise.  I took my son to the ER 6 weeks ago and recently received the EOBs for the services rendered.  I'm sompletely confused as to why I'm getting a bill for a 99283 & a 99284.  Here's the background.

My infant son was seen by an ARNP in the ER.  He had X-rays.  It turned out he had Nurse Maid's Elbow.  The ARNP tried to set his elbow with no success.  She called in the Dr. on staff that night and he attempted, again with no success.  He then contacted an Ortho via phone to see what steps should be taken next.  A nurse came in and splinted my son's arm.

I have gotten two bills.  One is from the Hospital for the X-rays, the Radiology Interp, and a 99283.  I then got a bill from the Dr. who had stepped in for a 99284.  All the services were provided in the same ER visit.  I contaced the billing dept for the physician who billed a 99284.  The billing department is for "Iowa Health Systems."  They only show records for the 99284.  I then contacted the hospital billing department, who is also under the umbrella of "Iowa Health Systems."  It seems that the Dr. who saw my son has privelages at the hospital and was working there for "Iowa Health Systems" that night.

What I don't understand is how a 99283 & a 99284 can be billed for the same ER visit by the same umbrella company.  The physician's billing department told me it was because "that's how insurance makes them do things.  It's a seperate TID you know."  Any help to shed some light on this would be greatly apreciated.  Thanks all!


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## mitchellde (Apr 11, 2012)

When a patient is seen in the facility setting there should be 2 E&M charges, one is the facility charge and one is the physician charge.


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## jimbo1231 (Apr 11, 2012)

*Can Happen*

As Deb mentioned one bill was for the hospital service or facility side; the other was for the physician service. They can be differerent levels since documentation requirements are different for physcian and facility. The physician side coding is based on published CPT guidelines and often based on the 1995 or 7 Medicare guidelines. The governmnt has general guidelines for the facility side coding of the ED. But there are a number of different approaches from point systems to ACEP Guidelines.This probably accounts for the difference between the 99283 and 4.

Jim


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## hnroberts (Apr 12, 2012)

Thanks all for the info.  It's always interesting to gain some insight into other specialties. =0)


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