ED Coding and Reimbursement Alert

Question: Our emergency department physician answered a code blue to a patient's room, and documented a history of present illness, review of systems, histories, and a physical exam. Should I report subsequent hospital care for this service? How should I code for an ED doctor who, when called to the floor, only ordered tests and observed what the nursing staff did?

Iowa Subscriber Answer: Your best choice for this scenario is to report one of these codes for subsequent hospital care:

99231 - Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least two of these three components: a problem-focused interval history, a problem-focused examination, and medical decision-making that is straightforward or of low complexity

99232 - ... an expanded problem-focused interval history, an expanded problem-focused examination, and medical decision-making of moderate complexity

99233 - ... a detailed interval history, a detailed examination, and medical decision-making of high complexity.

If the physician documentation does not support an evaluation and management service (99281-99285) and the physician didn't perform any separately billable services, you have nothing to report in a claim.

Typically, the physician responds to these kinds of calls as a service to the hospital or the medical staff. Of course, if your physician did provide legitimate E/M services, you should certainly report them.