tci ED Coding & Reimbursement Alert - 2004 Issue 7

Reader Question: Count Places, Not People, for ED Services

Question: How should I handle services rendered in the emergency department by non-emergency physicians, when there is no emergency-physician involvement? Should I report these services with 99281-99285? New Mexico Subscriber Answer: The bottom line: The ED evaluation and management codes are specific to the site of service, not the type of provider. If the non-emergency physician's services meet the criteria for an ED E/M service, you can appropriately assign one of the following codes: 99281 -- ED visit for the E/M of a patient, which requires these three key components: a problem- focused history, a problem-focused examination, and straightforward...

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