Eli's Rehab Report

Question: Can we use the CPT 99211 -99215 series of codes for ER visits? My insurer denies them saying that the ER is not an acceptable place of service for this code series. I believe when the physiatrist is called into the ER to assume care of a patient that we should bill using the 99211-99215 series rather than a consult. After all, the ER is considered outpatient.

Indiana Subscriber

Answer: Although the emergency department E/M codes (99281-99285) are not limited to the emergency department (ED) physician, that's usually the most likely person to bill that code series, and no insurer will pay both the ED physician and the physiatrist for these codes on the same day. You are correct in billing the outpatient E/M codes (99211-99215), particularly if an established patient calls the doctor and he tells the patient to meet him at the ED. Some insurers may say that those codes should be used only for office visits, but that's a misinterpretation on their part and a disregard for CPT guidelines. Payers see the place of service listed as an emergency room and immediately deny the claim, but you need to fight those denials. Write a letter to the insurer appealing the rejection, and indicate the patient's condition and why he required the doctor's specialty care in the ER.