Medicare Compliance & Reimbursement - 2017 Issue 8
Reader Question: ED Codes Don't Apply in the Office
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Article Overview
This article answers a practical coding question about whether emergency department evaluation and management codes apply when care is provided in a physician office. It is aimed at coders, billers, and office staff who need to distinguish facility setting rules from office visit reporting and understand the general treatment of an emergency-basis office service code under CPT guidance and payer policy. The article also notes the importance of payer-specific billing considerations.
Why This Topic Matters
Correct place-of-service selection and E/M code family selection affect claim accuracy and payment. The article helps readers avoid using a facility-specific code in an office setting and highlights that some payers may handle an emergency-basis office service differently.
What You Will Learn
- How emergency department E/M reporting is limited by service setting
- How office E/M codes relate to emergency care provided in a physician office
- How an emergency-basis office service is discussed in relation to routine office scheduling
- Why payer policy can affect whether an office-based add-on service is separately payable
Who Should Read This
- Medical coders
- Medical billers
- Physician office staff
- Practice managers
- Compliance staff
Codes Discussed
Code Ranges Discussed
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