Oncology & Hematology Coding Alert

Reader Questions:

99281-99285 Range Doesn't Apply to Phone Call

Published on Tue Jan 11, 2011

Question: One of our patients presented to the ER. The ER physician called our oncologist at home to discuss the patient, but the oncologist didn't go to the ER. Can I report an E/M for the ER-related service?

Answer: You should not report the phone call using a separate E/M code. If the oncologist had seen the patient in the ER, then you could report an ER code (99281-99285, Emergency department visit ...).

Support: Medicare Claims Processing Manual, chapter 12, section 30.6.11, states, "If the patient's personal physician does not come to the hospital to see the patient, but only advises the emergency department physician by telephone, then the patient's personal physician may not bill."

You may access the manual online at www.cms.gov/Manuals/IOM/list.asp.

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