Wiki ED Billing

[jaud63]

Does anyone know if it is possible to bill Emergency Department services for Non-ED physicians? We have specialists that are using the ED as an Urgent Care. Ex - patient calls the MD in the evening or on the weekend and the specialist tells the patient to meet him/her at the emergency department. The specialist bills an emergency department visit 99281-99285. I have worked in many specialties and have never seen non-ED providers bill for ED services. Please let me know if these services are billable or let me know how I can locate information pertaining to this.
Thanks

 

[lourdesgina]

ED Billling

The ED E & M codes are only to be billed by the attending ED physician. If any other physician or specialist sees a patient in the ED, they have to use the appropriate E & M codes and the place of service would be 23 for the ER.

 

[FTessaBartels]

As long as the doctor is the ONLY one

Any physician (not just ED specialist) can use the Emergency Room codes (99281-99285) AS LONG AS there is not an ED attending physician who is also treating the patient and using these codes.

In our practice there are times when a patient is brought to the Trauma Center and the ED physician calls the specialist (example: orthopedic surgeon) and bascially says, "you handle this." On the ED physician "note" we will see a notation similar to "Ortho only" which lets the coders know to NOT pick up any service for the ED physician and only code the specialist's services as documented.

So if your specialist gets a call at home in the evening and he tells the patient "Meet me in the ER," -AND- s/he is the ONLY physician providing services in the ER, then, yes that specialist can appropriately use the ER codes.

If there is an ED attending who is also providing services to this same patient, then the specialist should use the outpatient visit codes (POS 23) or the appropriate admission code (if admitting to the hospital). If the services are being provided between 10:00pm and 08:00am you can also use 99053. (Be sure the documentation lists the time of day of the service.)

Hope that helps.

F Tessa Bartels, CPC, CEMC