ED Coding and Reimbursement Alert

Question: Our emergency department physician often performs nebulizer treatments. What documentation is needed to bill for this service? Colorado SubscriberAnswer: Since the "incident to" rules do not apply in the ED, the physician would have to perform the service in order to bill for it. Occasionally, a physician's extra expertise is required to perform a nursing function. Examples of this include peripheral IV starts and difficult Foley catheters. Proper documentation would include a description of the procedure and why it was "bumped up" to the physician. However, it could be hard to find a reason why a physician's extra training would be useful in giving a nebulizer treatment And additionally the ED physician does not bear the expense of the supplies and medication. This scenario would more than likely not pass scrutiny in the area of medical necessity.