ED Coding and Reimbursement Alert

The May 2001 issue of ED Coding Alert incorrectly stated that in-house cardiac care management by an ED physician includes the ED E/M codes (99281-99285). Rather, these codes apply only to services performed in the ED.

When emergency physicians are requested in another area of the hospital, the extent of the service and the guidelines in force for the patients insurer determine how the service will be coded. If procedures are performed, the emergency physician may bill for those procedures. If the patient qualifies for critical care and the emergency physician has performed over 30 minutes on critical care management, critical care codes 99291-99292 may be used. Time spent performing otherwise billable services must, however, be deducted from the time that qualifies as critical care (see story this issue).

If the patient is admitted and the emergency physicians assistance meets the guidelines for consultation (opinion or advice regarding evaluation and/or management of a specific problem is requested by another physician or other appropriate source), the emergency physician who is requested to provide the consultative service would code the initial inpatient consultation (99251-99255). The request for the consultation by the physician or other appropriate source, as well as the ED physicians detailed documentation of the service, must be included in the medical record. Use of the consultation code does not preclude the physician from also billing for any additional procedures performed at the time of the consultation.