EM Coding Alert

Question: My physician was performing rounds at the hospital. He got a page that an established patient needed to see him urgently. Since he was at the hospital and not the office, he called the patient and told her to meet him in the emergency room. The physician saw the patient, performed a comprehensive history, comprehensive examination, and moderate complexity medical decision making. He then admitted the patient to the hospital for surgery. Do I report an emergency room encounter code for this encounter? What place of service code should I put on the claim?

Oklahoma Subscriber

Answer: The answer to these questions depends on whether or not your physician admitted the patient to the emergency room (ER). Since you didn’t say that happened, we’ll assume the patient was not admitted to the ER.

When the patient is not registered/admitted to the ER, you’ll use the outpatient place of service code, says Barbara J. Cobuzzi, MBA, CPC, COC, CPC-P, CPC-I, CENTC, CPCO, vice president at Stark Coding & Consulting, LLC, in Shrewsbury, N.J. You’ll use 22 (Outpatient hospital) instead of 23 (Emergency room – hospital).

You’ll report 99215 (Office or other outpatient visit for the evaluation and management of a new patient, which requires at least 2 of these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity …) assuming the nature of the presenting problem (NOPP) and medical necessity supports the level-five code. Since the patient isn’t registered as an ER patient, you can’t use 99284 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: a detailed history; a detailed examination; medical decision making of moderate complexity …).

Additionally, it seems the doctor saw the patient in the ER for his own convenience; otherwise, the patient’s condition would have warranted only an office visit.