Wiki E&M visit results in patient being directed to ER by provider

[AR2728]

There has been debate over the years in our office regarding whether an E&M should be billed for the following scenario.
A patient is treated by a physician-a history, physical exam, and MDM are completed-however, the visit results in the patient being directed to ER by the provider.

I understand the view of not billing the patient because treatment was continued elsewhere, and the patient may feel that our provider did nothing for them. However, our physicians are completing all components of an E&M, thoroughly evaluating the patients condition, and should be paid for their services. The most recent circumstance that involved this type of situation involved our provider performing an EKG in office which resulted in immediate referral to the ER.

This situation does not occur frequently, however, there is still debate over what is appropriate. Does your office have a protocol for these situations?

 

[LLovett]

I have seen this a lot over the years. In most cases it is due to a misapplication of the guidance related to seeing a patient in the office then sending them to the hospital and admitting them.


If a provider sees a patient in the office and recommends they go to the ED that provider should document what they did and bill for what the documentation supports.

It is no different than if they saw a patient and referred them to any other specialist when you think about it. Obviously there is a level of urgency involved but other than that they are the same concept.

My thoughts for what its worth,

Laura, CPC, CPMA, CEMC

 

[AR2728]

I appreciate the thoughts and rationales from others. Your comparison to referral to a specialist will be helpful in explaining this reasoning to other staff and providers.
Thank you
April