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. I don’t think we’re allowed to do that in the ED, but the physician wants me to report a prolonged visit code for “face to face” time. Should I?

New York Subscriber

Answer: You shouldn’t bill for the extra time. The 9928x (Emergency department visit for the evaluation and management of a patient…) series for emergency department E/M services is not time based, so billing for extra time using a prolonged services code does not apply. The time required for a level 5 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.

As a specialty, the emergency department 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.