ED Coding and Reimbursement Alert

Question: A patient presented to the ED on a Monday at 11:05 p.m. The patient received some initial treatment, including an expanded, problem-focused history and physical, and moderate medical decision-making. However, the physician didn't admit the patient to observation until Tuesday at 1:37 a.m. Later that day, she discharged the patient. Could I charge 99283 for Monday's services, and 99217 (Observation care discharge ...) for Tuesday's?


South Dakota Subscriber


Answer: Because CPT evaluation and management codes describe services performed on a specific calendar day, it is permissible to report a separate E/M code for each date of service. Make sure, though, that you choose the code that most accurately describes the service the doctor provided.

In the scenario above, it might be appropriate to bill an emergency department E/M code on day one and an observation code on day two. In this case, you would probably report 99283 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: an expanded problem-focused history, an expanded problem-focused examination, and medical decision-making of moderate complexity) for the E/M service on Monday, and then choose a code from 99234-99236 (Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date) for the same-day observation admission and discharge on Tuesday.

Note: The physician would have to meet the full documentation requirements for each code, and you should verify the documentation requirements of your specific payer.