# Er Hospital Based Vs Er Physician Based



## kishacajun (Aug 18, 2008)

Questions:
1.  What's The Difference?
2.  What Codes Do I Pick Up?
3.  Do I Assign Volume 3 Icd9 As Well At Cpt Codes For Hospital Based Er Coding?
4.  In Hospital Based Er Coding, Do I Pick Up Everything That Was Done Including Orders, Splints, Procedures, Iv, Oral Meds, Etc

First Time Having To Do Hospital Based Er Coding...i Need Help Ladies!!!!!!!  Oh, And Gents!!!!!!!!!!!!!!

Thanks


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## MMartin525 (Aug 18, 2008)

In ER coding, you do code for the procedures, too. When I code it's from a T-sheet that the phy. has given the dx and I'm not sure what your asking about the difference between hospital and phy based codes? So, not sure if you are going to be doing the same thing that I do or not. But that's how i have been taught.


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## kishacajun (Aug 18, 2008)

Ok So Do I Use A Volume 3 Procedure Code From The Icd9 Book To Capture The Procedure? Or Do I Use A Volume 3 Icd9 Code Along With A Procedure Code Out Of The Cpt Book?


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## amiles02 (Aug 18, 2008)

If you are billing ER physicians who are not employed by the hospital (they have their own practice and simply work at the hospital) you will bill the same as you would for other physicians with the appropriate place of service.  

Medicare Only:  If you are billing for hospital employed ER physicians, their charges will be billed with the appropriate CPT E&M code and Revenue Code (0981 Prof fee ER),  The charge is split billed  & Facility portion of the CPT E&M is billed via the nursing acquity guidelines for the hospital. So, the ER MD could bill a level 4 ER visit and the Nursing Acquity visit could be a level 3 ER visit. They don't have to be the same.  The billing (incl Revenue Code/CPT cross walk) is probably set up in the hospital billing system.  Billing Medicare services on a UB is another world.  You have to know that Vaccines need a condition code A6,  there are occurrance codes that  may need to be added.  If this is what you must code, I suggest you go to the Part A carriers site and read the billing manual and get references for condition codes and occurrance codes.  Plus. . . oh by the way. . . if you have several say lesion removals . . all the charges are put on one line item and the balance of the line items should show $0 but the correct codes and modifiers.  Such fun.  Good luck.


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## jszewczyk (Apr 1, 2022)

it is all a big mess 
Hospital uses their own grid for calculating the levels V usually 3 and more tests it is level V no matter how is or not sick is the patient. 
They can be doing every patient's X-ray infusion and lab test and they will all bill level V. Is this compliant, I do not agree but I ma nit the doctor


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## thomas7331 (Apr 2, 2022)

jszewczyk said:


> it is all a big mess
> Hospital uses their own grid for calculating the levels V usually 3 and more tests it is level V no matter how is or not sick is the patient.
> They can be doing every patient's X-ray infusion and lab test and they will all bill level V. Is this compliant, I do not agree but I ma nit the doctor


This is compliant - CMS allows hospitals to set their own rules for determining ED levels on the facility claims.  For facilities, levels are determined differently from professional claims because the codes represent resource usage, not the amount of physician work or the severity of the patient's illness.   The doctors must follow CPT rules for determining levels based on history, exam and MDM appropriate to the presenting problem, but facilities do not. 

Some commercial payers (e.g. UnitedHealthcare and Anthem) will downgrade facility levels if the diagnosis does not support it.  From what I've heard, this is being fiercely contested by hospitals across the country and I imagine that it will likely end up in a large court case and/or settlement.


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