Wiki Hospitalist sees patient in ER

[Carol Hudgens]

So the question has been presented to our billing department concerning what E/M code should the hospitalist use if he sees a patient in the ER to evaluate the patient and then it is decided after observation and testing that the patient does not require admission to the hospital, what CPT code is billed for the services rendered? Is it considered an Outpatient (99213-99215) code or is it considered an ER code 99281-99284). Has anyone had this experience with coding these services?

 

[thomas7331]

So the question has been presented to our billing department concerning what E/M code should the hospitalist use if he sees a patient in the ER to evaluate the patient and then it is decided after observation and testing that the patient does not require admission to the hospital, what CPT code is billed for the services rendered? Is it considered an Outpatient (99213-99215) code or is it considered an ER code 99281-99284). Has anyone had this experience with coding these services?

If the patient was admitted to an observation status during this time, then the hospitalist would use the codes from the observation CPT code range (e.g. 99219-99220). But if the hospitalist is simply performing a consultation for the ER physician and does not admit the patient, then the ER codes are appropriate for Medicare and/or payers that do not accept the consultation CPT codes - as a reference, see MLN article MM6740.