# ER Visit Codes



## Herbie Lorona

When you are seen in the ER the hospital will bill for the 9928*. So what does the physician that seen you bill for?


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## LTibbetts

The hospital bills a facility fee (9928x) and the physician charges for a professional fee (9928x). There is both a professional and facility component to all ER visits, depending on who you are coding for.


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## Herbie Lorona

So they both will bill the same code?


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## Herbie Lorona

If you are talking about technical and professional components it doesn't apply for these codes from what I see!


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## Anna Weaver

*ER visit codes*

The facility is allowed to charge for the visits as well as the physicians. The facility charges are for the room/bed, the supplies used, the instruments used, and any procedures done (this is where the TC/26 comes in), etc. The physician is also allowed to charge for seeing the patient, they use the facility (so the overhead belongs to the ER/hospital) and they will bill according to their documentation. They may not always have the same CPT code, but it's generally close because the more traumatized/sick the patient, but more supplies/instruments/parts of the facility, will be utilized.
Does this make sense? Sometimes I have trouble saying what I'm trying to get across. I lose something between my brain and my fingers.


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## Herbie Lorona

Yes it does make sense but when I am looking up the fee schedules for that online it does not show that code has a professional or technical component with it.


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## mitchellde

The visit levels do not have a professional and technical component.  This came about in 200 with APCs.  Facilities had to have a way to account for the utilization of the facility resources that are consumed in a patient visit.  Think of anything that cannot be accounted for with a CPT or HCPC II code.  Otherwise it cannot be billed.  So they made available for facility use the E&M codes.  The facility uses the same codes but they mean different things to the facility.  That is why you do not see professional and technical components.  Also FYI the facility now has HCPC II codes to use for the ER visit levels and they still use the 992xx codes for clinic visits.


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## Herbie Lorona

So when the ER is billing you for that code it is correct? It just seemed weird when I received a bill from the er physician and from the hospital and they both are charging me alot for the same code.


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## eadun2000

both professional and facility use 99281-99285, along with cc codes 99291-99292.  One is for the physician and the other is for the facility... that is ER coding.


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## malana

Anna Weaver said:


> The facility is allowed to charge for the visits as well as the physicians. The facility charges are for the room/bed, the supplies used, the instruments used, and any procedures done (this is where the TC/26 comes in), etc. The physician is also allowed to charge for seeing the patient, they use the facility (so the overhead belongs to the ER/hospital) and they will bill according to their documentation. They may not always have the same CPT code, but it's generally close because the more traumatized/sick the patient, but more supplies/instruments/parts of the facility, will be utilized.
> Does this make sense? Sometimes I have trouble saying what I'm trying to get across. I lose something between my brain and my fingers.


Is the physician and the hospital both using POS 23.


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## mitchellde

Facilities do not bill on a CMS 1500 they use a UB-04 and do not use POS codes at all, it is a completely different billing system.


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