Don't Let ED Services Cause You a Coding 911

You'll report different codes if your endocrinologist admits the patient
You've reported subsequent hospital care codes for your endocrinologist's inpatient services, but do you know how to handle the tricky coding situation when your physician treats his patient in the emergency department (ED) before admission to the hospital?
 
To choose the right code, you'll need to consider whether the patient requires admission and whether the attending ED doctor already provided some care.
 
For many endocrinologists, treating a patient in the ED is "pretty rare" because the patient is usually admitted by the time the physician can get to the hospital, says Stephanie Swain, a coder with North Atlanta Endocrinology & Diabetes in Lawrenceville, Ga. However, even if your physician makes only five ED visits per year, you could easily encounter one of the four basic ED coding scenarios below.
 
Don't forget: Even though you won't face these scenarios daily, you should learn how to handle them. Remember, proper reimbursement will hinge on your selection of the correct code.
 
1. Your physician visits his patient after the ED doctor has already admitted the patient. Because the patient is now an inpatient, you should report any services your physician renders with a subsequent hospital care code (99231-99233), says Keri Hegberg, CPC, owner of Gulf Coast Coding in Fort Myers, Fla.
 
You might be tempted to report an initial hospital care code (99221-99223) because the visit is your physician's first with the patient, but CPT states that these codes "are used to report the first hospital inpatient encounter with the patient by the admitting physician" [emphasis added]. Therefore, the ED doctor could report any initial inpatient services using this code series.
 
CPT also states that "for initial inpatient encounters by physicians other than the admitting physician," coders should choose from initial inpatient consultation codes (99251-99255) and subsequent hospital care codes. Because your physician has treated the patient before and is not simply offering consultive service, a subsequent hospital care code would be most appropriate.
 
2. Your physician visits his patient in the ED and decides to admit the patient. Because the attending ED doctor already performed initial treatment billable with an ED services code, you should bill the appropriate-level initial hospital care code for the hospital admission and any other services your physician renders that day.
 
3. Your physician visits his patient and is the first provider to render treatment (the ED doctor has performed no billable services thus far). You should bill an ED services code (99281-99285) for the treatment your physician provides within the ED, Hegberg says.
 
4. Your physician visits his patient in the ED and renders treatment in addition to the services the attending ED doctor has already provided. If neither physician [...]

- Published on 2004-08-26