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ED Coding and Reimbursement Alert

Reader Question:

Coding for 99288

Published on Mon Jan 01, 2001

Question: When coding for 99288 (physician direction of emergency medical systems [EMS] emergency care, advanced life support) are any guidelines available that provide standards and/or specific documentation that is required when assigning this code for billing? For example, can we use this code only in advanced life support circumstances such as respiratory failure?

Barbara Gedwill
Mequon, Wis.

Answer: There are no specific guidelines, outside of the instructions in CPT, page 21 of the 2000 professional edition and page 19 of the 2001 professional edition. The descriptor of the code states advanced life support (ALS), which indicates that the patients condition must meet ALS criteria before this code is valid. By the way, Medicare and some other carriers do not allow payment for this code. The communication between ER physician and EMT/paramedics is considered included in the ER charge and is not reimbursed separately.
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