The Emergency Department (ED) codes (99281-99288) are designed for any physician seeing a patient that is registered in the ED, not just the ED provider. The examples below will help explain the topic.

  1. Patient presented to the ED. Dr. A (ED physician) saw the patient and decided to contact the patient’s personal physician, Dr. B, who came to the ED to see the patient. Dr. B discharged the patient to home. In this example, both Dr.’s A and B can bill the ED Codes, based on the supporting documentation.
  2. Patient presented to the ED.  Dr. A (ED physician) saw the patient and decided to contact the patient’s orthopedic provider, Dr. B, who came to the ED to see the patient. Dr. B admitted the patient to the hospital (inpatient). In this example, Dr. A can bill the ED Codes, based on the supporting documentation, and Dr. B (orthopedic surgeon) should bill an initial hospital care codes, again based on the supporting documentation.
  3. Patient presented to the ED at the request of his endocrinologist. The patient is NOT registered in the ED. The patient is only seen by his endocrinologist. In this example, the endocrinologist would bill the outpatient codes (99201-99215), based on supporting documentation, because the services were not rendered in the ED but rather in a hospital outpatient setting (POS22).

The important thing to remember is that the ED codes are not just for the physician that is assigned to ED, but that they can be used by any physician who sees a patient that is registered to the ED.

Sources:
2015 CPT®Professional Edition Manual (American Medical Association). Pages 21-23.
CMS Claims Processing Manuel, Chapter 12: “Physician/Nonphysician Practitioners”, 30.6.11, http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c12.pdf

Author - Female

About the author

Lori Johnson, CPC, CPMA of Compliance—Academic, Multi-specialty and Office-based Medicine, McKesson Business Performance Services.