Wiki E&M codes to rule out for hospital?

[rkindlund]

Our general surgeons work trauma and call at the hospital. They have been in the habit of billing 99201-99205 codes for ER and observation visits. Although these patients are technically outpatients until they are admitted, after studying I think it's safe to say there is no scenario under which my docs should use the 99201-05 codes for the hospital. I believe patients are either ER, observation or inpatient, so our docs should be using codes from those areas instead. Does this sound right? Or are there any legitimate uses for the 9920_ codes in the hospital setting?

 

[OCD_coder]

This is a very basic explanation, not all details are identified here.

ER E&M codes are not limited to just ER physicians as this a point of service code set, if the patient is seen in the ER and the trauma docs are not admitting them under their service (eg. hospitalist/admit doc) then they should be using this code set.

If the patient is admitted under the hospitalist service under the Observation status, the trauma doc cannot bill Observation codes - this is a scenario where the 99201-99215 code set would be appropriate. There can only be one provider that can bill OBS codes on a given DOS.

If the patient is admitted "Inpatient" status formally by the hospitalist and the trauma doc is called for a consult/non-MCR/MCD patient they could use the consult code set. If the documentation does not meet the criteria or if it's a MCR patient then the appropriate Inpatient/subsequent E&M code is recommended.

 

[rkindlund]

Thank you - that is helpful!