Pulmonology Coding Alert

Question: Our pulmonologist saw a patient in his office for an emergency. Can I use the emergency department E/M codes to report this visit?

Codify Subscriber

Answer: No, you cannot report ED E/M codes (99281-99285, Emergency department visit for the evaluation and management of a patient, which requires these 3 key components ...) for services your physician provided in his office.

As evident within the description of that code family, the visit must take place in a recognized emergency department with a patient who has been formally registered as an ED patient. According to the CPT® 2017 manual, you should only report ED E/M codes in an "organized hospital-based facility" that provides unscheduled, sporadic services to patients who require immediate medical attention. An ED must be open 24 hours a day.

In your case, you would report the appropriate office E/M code (like 99201-99205 for new patients or 99211-99215 for established patients) for the visit.

If your pulmonologist's routine in handling other patients for the day was disrupted because of the emergency visit that your clinician undertook, you can report 99058 (Service[s] provided on an emergency basis in the office, which disrupts other scheduled office services, in addition to basic service) along with the E/M code that you are reporting for the visit.

Important: Medicare and many other payers consider code 99058 to be a "bundled" service and will not separately pay for it. If you make the patient wait until you can fit them into the schedule, this would not qualify as a "disruption." Additionally, this type of charge may be viewed by the patient as unreasonable, and is not good for public relations.