ED Coding and Reimbursement Alert

Question: What should we report when we’re treating a patient who is being transported by EMS?

Codify Subscriber

Answer: In some situations, you can separately report the transport to or from another medical facility. The emergency physician is often involved in these transfers, but not all of that work is separately reportable from the E/M service that the ED physician reports.

If the ED physician provides medical direction via radio to EMS personnel

in the field, you should report 99288 (Physician or other qualified health care professional direction of emergency medical systems [EMS] emergency care, advanced life support).

To report this code, you must be providing transports of an emergency nature requiring advanced life support rather than a routine transfer, or even transporting a patient from a nursing home to the emergency department for a routine checkup. CPT^®  says that the code is intended to cover the direction of necessary medical procedures including but not limited to: telemetry of cardiac rhythm, cardiac or pulmonary resuscitation, endotracheal or esophageal obturator airway intubation, administration of IV fluids, or administration of intramuscular, intratracheal or subcutaneous drugs and electrical cardioversion.

Keep in mind, however, that Medicare assigns zero RVUs to 99288 and many payers don’t cover it because they consider it to be part of the preservice work of the E/M service when the patient arrives at the ED and the physician takes over the patient’s care. In the less likely event that the radio direction is for a patient that does not come to the ED where the physician is working, no face-to-face encounter takes place and you can’t report another code.

If, however, the emergency physician is actually present during the patient transport, CPT^® does include specific codes for transporting critically ill or injured pediatric patients under two years of age requiring the physical attendance and direct face-to-face care by a physician during the interfacility transport.

These are 99466 (Critical care face-to-face services, during an interfacility transport of critically ill or critically injured pediatric patient, 24 months of age or younger; first 30-74 minutes of hands-on care during transport) and +99467 (…each additional 30 minutes [List separately in addition to code for primary service]). Keep in mind, however, that there is no similar code for non-pediatric patient transfers.