The emergency department is
an organized hospital-based facility for the provision of unscheduled services
to patients who needs immediate medical attention.
As
per CMS guidelines any physician seeing a patient in the ED (Emergency
department) can use emergency department visit codes (99281 - 99285).
We should not assign ED
codes if the place of service is an office or outpatient settings or any other
place of service. The emergency department codes should only be used if the
patient is seen in the emergency department.
Note: If the physician asks the patient to meet
him instead of his office then we should assign office or outpatient visit
E&M instead of ED codes.
Services provided to the
patient in the emergency department may not be emergency condition. Even though
we can assign the ED codes if the described services are provided. Usually a
lower level ED code would be billed for a non-emergency condition.
The nursing facility is not
paid on the same day Emergency department visit was provided to the patient.
If a physician advises
his/her own patient to go to an emergency department (ED) of a hospital for
care and the physician subsequently is asked by the ED physician to come to the
hospital to evaluate the patient and to advise the ED physician as to whether
the patient should be admitted to the hospital or be sent home, the physicians
should bill as follows:
If
the patient is admitted to the hospital by the patient’s personal physician,
then the patient’s regular physician should bill only the appropriate level of
the initial hospital care (codes 99221 -99223) because all evaluation and
management services provided by that physician in conjunction with that
admission are considered part of the initial hospital care when performed on
the same date as the admission. The ED physician who saw the patient
in the emergency department should bill the appropriate level of the ED codes
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.
ED Physician requests
another physician to see the patient in ED or office/outpatient Setting
If
the emergency department physician requests that another physician evaluate a
given patient, the other physician should bill an emergency department visit
code. If the patient is admitted to the hospital by the second
physician performing the evaluation, he or she should bill an initial hospital
care code and not an emergency department visit code.
___________________________________________
CPT 99281 – Emergency
department visit for the evaluation and management of a patient, which requires
these 3 key components: A problem focused history, a problem-focused
examination, and straightforward medical decision making. Counseling and/or
coordination of care with other providers or agencies are provided consistent
with the nature of the problems and the patient’s and/or family’s needs.
Usually, the presenting problems are self-limited or minor.
CPT 99282 - Emergency
department visit for the evaluation and management of a patient, which requires
these 3 key components: An expanded problem focused history; an expanded
problem-focused examination; and Medical decision making of low complexity.
Counseling and/or coordination of care with other providers or agencies are
provided consistent with the nature of the problem(s) and the patient's and/or
family's needs. Usually, the presenting problem(s) are of low to moderate
severity.
CPT 99283 - Emergency
department visit for the evaluation and management of a patient, which requires
these 3 key components: An expanded problem focused history; an expanded
problem-focused examination; and Medical decision making of moderate
complexity. Counseling and/or coordination of care with other providers or
agencies are provided consistent with the nature of the problem(s) and the
patient's and/or family's needs. Usually, the presenting problem(s) are of
moderate severity.
CPT 99284 - Emergency
department visit for the evaluation and management of a patient, which requires
these 3 key components: A detailed history; A detailed examination; and Medical
decision making of moderate complexity. Counseling and/or coordination of care
with other providers or agencies are provided consistent with the nature of the
problem(s) and the patient's and/or family's needs. Usually, the presenting
problem(s) are of high severity and require urgent evaluation by the physician
but do not pose an immediate significant threat to life or physiologic
function.
CPT 99285 - Emergency
department visit for the evaluation and management of a patient, which requires
these 3 key components within the constraints imposed by the urgency of the
patient's clinical condition and/or mental status: A comprehensive history; A
comprehensive examination; and Medical decision making of high complexity.
Counseling and/or coordination of care with other providers or agencies are
provided consistent with the nature of the problem(s) and the patient's and/or
family's needs. Usually, the presenting problem(s) are of high severity and
pose an immediate significant threat to life or physiologic function.