Urology Coding Alert

Question: Our doctor was called into the ER and dictated a consult with the location as ER. The patient was currently residing in an advanced care hospital. Our experience has been that Medicare will deny the claim and state that we need to bill the nursing facility, which we did. However, the nursing facility received a bill from the ER, and they billed the same code (99284) as we did. The ER doctor and our doctor that was called into the ER both saw the patient. The advanced care hospital is going to pay the ER bill but not our doctor. Can more than one doctor bill this code on the same day? 

Idaho Subscriber

Answer: Two providers can bill emergency room (ER) codes 99281- 99285 (Emergency department visit for the evaluation and management of a patient ...) for one patient on the same day if both physicians examined and treated the patient in the ER, especially if one is answering a consult request from the other. 

Caution: In your case, however, the advanced care hospital you are billing apparently does not follow this policy. Unfortunately, if that is their policy, they may not pay both providers for 99284. 

Solution: In order to receive proper payment, ask the hospital how they want you to bill for the services of two physicians of different specialties seeing the patient at the same encounter in the ER.