ED Coding and Reimbursement Alert

Question: One of our physicians spent 30 minutes speaking with a suicidal patient and wants to bill for the time using a prolonged visit code for face-to-face time. Are we allowed to report that in the ED?

New York Subscriber

Answer: You shouldn't bill for the extra time. The 99281-99285 series for ED E/M services is not time-based, so billing for extra time does not apply. The time required for a level-five E/M code, which your patient's condition warrants, is open-ended. You can deny your physician's request on the grounds that time is not a criterion for reporting face-to-face encounters while speaking to the suicidal patient. The ED is generally reimbursed for high-intensity, short-duration work, which usually ends up benefiting the ED. The ED is better off losing the occasional patient who requires additional time to keep rewards for high-intensity work that is independent of time.