ED Coding and Reimbursement Alert

Question: Many of our patients receive intravenous fluids for four to six hours in the emergency department. How should we bill for this prolonged service? What about patients we watch for eight hours who have pain or fever related to sickle-cell disease?
     
Tennessee Subscriber

Answer: CPT states that time is not a descriptive component for levels of E/M services in the emergency department (99281-99285). Therefore, the prolonged services codes 99354-99357 would not apply in the ED. However, the services you provide to certain patients in the ED may meet the requirements to bill for observation services.

Physicians frequently provide observation services in the ED to patients who either lack a definitive diagnosis or have the need for intermediate-term, higher levels of therapeutic intensity. Although CPT has no minimum time requirement, Medicare requires eight hours of observation services to use the same-day code series 99234-99236. On the facility side, Medicare will only recognize the clinical conditions of asthma, CHF and chest pain.