Wiki Two Professional E/M Emergency Codes

[jdmc1973]

We've run into an issue and are trying to sort it out, but CMS is not being thorough in their explanation for this type of situation. If a patient comes into the ED and is seen by Provider A, and then Provider B is called down for a specialty consult, do both providers bill an emergency E/M code or does just one bill? It seems it would hit an edit somewhere, either internally or the clearinghouse and get denied as a duplicate service.

CMS only gives a scenario when the second provider admits the patient, but what if that doesn't happen?

 

[thomas7331]

Both providers would bill an emergency E/M code in this case. It should not hit an edit as long as the providers are of different specialties. The MLN Matters article # MM6740 details this pretty well and is a good reference.

 

[Cynthia Hughes]

Agree. See also section 30.6.11.E in chapter 12 of the Medicare Claims Processing Manual. If the ED physician, based on the advice of the patient’s personal physician who came to the emergency department to see the patient, sends the patient home, then the ED physician should bill the appropriate level of emergency department service. The patient’s personal physician should also bill the level of emergency department code that describes the service he or she provided in the emergency department. If the patient’s personal physician does not come to the hospital to see the patient, but only advises the emergency department physician by telephone, then the patient’s personal physician may not bill.