Reader Question: ED Visit Codes

Question: Our ED and its fast-track component share the same triage RN and registration staff. RNs float between the ED and the fast-track area. Our patient-accounts staff says that claims using the revenue code for urgent care are being denied. We are using ED visit codes 99281-99283, which are priced lower than the regular ED charge. Would it be appropriate to use the revenue code for ED for these patients? This is not a designated area with its own hours, it is simply a fast track through our ED, 24 hours a day, using the same ED staff.

Louisiana Subscriber

Answer: Your fast track, by any other name, is the emergency department. As long as the patient comes to the hospital seeking emergency, nonscheduled care, you should use the CPT codes created for the ED series 99281-99285 (ED visit for the evaluation and management of a patient, which requires ...) and identify the revenue center as the ED. This approach will eliminate the denials for the revenue center and maintain regulatory compliance. If your hospitals strategic plan is to market the fast track as an inexpensive, quick alternative to the ED, it might be better to open a true urgent-care center located away from the hospital campus and use office codes for billing.

Answers to Reader Questions and You Be the Expert were provided by Caral Edelberg, CPC, CCS-P, president of Medical Management Resources Inc. of Jacksonville, Fla.; John Turner, MD, FACEP, medical director for coding and documentation at TeamHealth Inc. of Knoxville, Tenn.; and Laurie Castillo CPC, CPC-H, CCS-P, professional coding and compliance consulting of Manassass, Va.

- Published on 2001-06-01