Wiki Urgent need of help

[Sassy1]

I am a brand new coder that needs help with coding E/M. I have a patient that went to ER with severe abdominal pain. Upon examination, the patient was admitted to the hospital and had an appendectomy the following day. Would I use the inpatient E/M code or the ER code?

 

[natashabarnes]

Admit code

 

[thomas7331]

I really depends which service you are coding - if you're coding for the ER physician then it would be the ER codes. If you're coding for the physician who admitted the patient, then you would use the initial inpatient codes. If it's a consultation, then it would depend on where and when the patient was seen and whether or not the payer is Medicare or follows the Medicare consultation guidelines.

 

[NishaJ]

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R1465CP.pdf

A. Initial Hospital Care From Emergency Room
Contractors pay for an initial hospital care service or an initial inpatient consultation if a
physician sees his/her patient in the emergency room and decides to admit the person to
the hospital. They do not pay for both E/M services. Also, they do not pay for an
emergency department visit by the same physician on the same date of service. When the
patient is admitted to the hospital via another site of service (e.g., hospital emergency
department, physician’s office, nursing facility), all services provided by the physician in
conjunction with that admission are considered part of the initial hospital care when
performed on the same date as the admission.

 

[cgaston]

As thomas7331 stated, which code you choose will depend on who you are billing for.

If you are billing for the ER physician, choose ER codes.

If you are billing for the admitting physician, you choose admission codes.

If you are billing for a physician who was asked to consult regarding this patient but he/she did not admit, then choose the consultation codes.