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amatlack

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Hopefully someone can help, we coders have an ongoing debate, we work for an orthopaedics group that take the call at both hospitals. One of our doctors is in the habit if treating the patient in the ER he will code CPT range 99281-99284 because he treated the patient in the emergency room. Some of us believe that only the hopitalist can bill this and others believe that if the patient is treated in the ER and the criteriea is met that the specialist can also charge for an ER visit. The only guidelines I can find for this are dated back in 2009 or earlier. I need updated information on this to determine if this is still okay or not. I am located in Washington state and am subject to Noridian Medicare guidelines, and yes I checked their website and found nothing new on this. Any up to date information would be helpful for our next compliance meeting.
Thanks mucho!!!
Ann :confused:
 
Per the CPT book descriptions and MCR manual, this is a point of service driven code and any phsyician specialist or otherwise can bill ER CPT codes. It is not limited to the hospitalist or and ER doctor and certainly does not exclude a specialist like your orthopedists. You essentially could have several ER CPT codes billed for one encounter, but for very different specialties. This is just a legend. I think the mis-interpretation comes from the AHIMA rule: Only one ER E&M code can be billed per DOS. They mean per group of ER physicians, compare to a practice/clinic group. Specialists are not typically part of that same "group" and fall outside of that rule.

If the hospitalist see the patient in the ER and admits the patient, they will use the Initial Inpatient Admit codes.

The orthopedist could potentially bill an outpatient consult code if the documentation met the requirements. They are being asked for their opinion by the ER physician.

Source:“Any physician seeing a patient registered in the emergency department may use emergency department visit codes (for services matching the code description). It is not required that the physician be assigned to the emergency department.”
- Medicare Manual 30.6.11 – effective date 01/10/11
 
My understanding is that a physician can see a patient in the ER, as long as requirements are met. But, what do you mean by "...specialist can also charge for an ER visit"?
 
The Mcare manual has a section on this that specifically address that if the provider is called to the ER to see a patient he uses the ER level of care (99281-99285)
 
what about for a non-medicare patient. The provider billed a consult which it can be billed with pos ER however he doesn't have the referring source and why they are been consulted. I want to crosswalk the consult to an ER
 
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