ED Coding and Reimbursement Alert

Question: When the ED physician is called to the floor to evaluate an inpatient and the visit does not qualify for critical care, what evaluation and management (E/M) code would be correct to use for the encounter?

Michigan Subscriber

Answer: There are three general groups of E/M codes the ED physician can use depending upon the service provided beyond the critical care codes.

1. If the ED physician was formally asked by the patients attending physician to assess the patient for a particular reason and that request was recorded in the patients chart either by the attending physician or by a nurse who recorded the order, then this could be considered a consultation and billed using consultation codes 99251-99255.

2. If no formal request was made and recorded in the chart, then the ED physician must use the subsequent inpatient visit codes 99231-99233. This is probably the most common situation.

3. If a procedure is performed, such as CPR, the appropriate service code would be used. Depending upon the circumstance, an E/M code could be used in addition to a procedure code, but the documentation must be complete to support the visit code in addition to the procedure code.

In all of these instances, the ED coder should take care to record the appropriate place of service (21, inpatient hospital) on the HCFA-1500, rather than the place of service for the ED (23, emergency room, hospital).