# Physican ordered infusion in ED



## victoria1113 (Jan 25, 2011)

I work for a CAH hospital in rural PA & we are having a debate regarding outpatient non-emergency services provided in the ER.  Basically, a patient was seen in their physician's office and given an order for IV drug administration & the infusion was to take 4-5 hours.  We do not have an infusion clinic in our hospital and the short procedure unit was too full to take the patient.  Therefore, the patient was given the infusion in the ER & there is a debate as to whether or not an ER facility fee can be charged.  I say no, as does another coder in my office.  The patient was not seen by the ER physician; they had an outpatient order in hand & presented for an outpatient service NOT an ER service.  Anyone else come across this scenario? 

Thanks,
Vicki/CPC
PA


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## eadun2000 (Jan 25, 2011)

Yes you should charge on the facility side.  The physician does not need to see the patient in order to charge for the facility.   The patient is taking up time and resources of the ER and should definitely be billed on the facility side.


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## victoria1113 (Jan 26, 2011)

Maybe I didn't make myself clear.  I agree we should charge for the infusion service, but I don't feel they should be charged a "facility" ER visit - the facility side of the E/M.  The patient did not present as an ER patient - our facility placed them in the ER for this outpatient service.  If they had the infusion on the short procedure unit, they would be charged for the infusion only.  I feel charging them for the facility ER visit in this case is wrong.  The ER nurse is not triaging the patient, she is simply carrying out the order that was written based upon a previously provided E/M in the physician's office.


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## jvargocpc (Jan 26, 2011)

I would have to agree with you, Victoria. I wouldn't feel comfortable charging an ER facility charge when the ER is just being used for "overflow" location. 

If the nurse is using the same items to run the infusion as would be used in your other location, and no further work or treatment is being done to the patient, the only charge would be the outpatient charge. 

We also run IVs in a room just off our ER with our ER nurses starting, watching, documenting, etc., and we don't charge an ER charge, just the infusion charge.


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## mitchellde (Jan 26, 2011)

The facility has the same requirement for a 25 modifier as the physician, so... If the patient was scheduled or it was known that the patient was comming in for IV infusions then there would be no visit level regardless of place of service.


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## victoria1113 (Jan 26, 2011)

Thank you both for your input!!!  It is greatly appreciated.


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