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Railroad Medicare
If my patient is registered in the emergency department and I am asked to see him/her, may I submit the emergency service?

Answer: 
Yes. Any physician seeing a patient registered in the emergency department (ED) may use ED visit codes for services matching the code description. It is not required that the physician be assigned to the ED. If the patient is admitted by this provider, the initial hospital service (CPT codes 99221-99223) with the AI HCPCS modifier would be submitted instead of the ED visit codes. Please keep in mind the service must be medically necessary and the documentation must meet the level of complexity of the service rendered.

The following guidelines apply to the ED CPT codes 99281 through 99285 billing:

  • ED service is provided to the patient by both the patient's personal physician and ED physician. If the ED physician, based on the advice of the patient's personal physician who came to the ED to see the patient, sends the patient home, then the ED physician should bill the appropriate level of ED service. The patient's personal physician should also bill the level of ED code that describes the service he or she provided in the ED. If the patient's personal physician does not come to the hospital to see the patient, but only advises the ED physician by telephone, then the patient's personal physician may not bill.
  • If the ED physician requests that another physician evaluate a given patient, the other physician should bill an ED visit code. If the patient is admitted to the hospital by the second physician performing the evaluation, he/she should bill an initial hospital care code and not an ED visit code.

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last updated on 03/04/2014
ver 1.0.43