Health Information Management

Tip: Coding for ED visit when the patient is admitted

APCs Insider, September 13, 2013

Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

A surgeon sees a patient in the ED and then makes decision for surgery. The patient is eventually admitted and has inpatient surgery. How you code this encounter will be affected by the payer (Medicare or other payer) and the disposition of the patient (discharged home or admitted to the hospital).

Medicare states that an E/M service provided by a surgeon in the ED should be reported using ED E/M codes (99281–99285), unless the service qualified as a consult, critical care, or an admission.

If the patient was admitted to the hospital for a surgical procedure, you would report an initial hospital care code (99221–99223). The ED service would be rolled into the inpatient code and not reported separately.

Because the surgeon’s ED evaluation resulted in a decision to perform surgery, the surgeon should report one of the initial hospital care codes appended with the -57 modifier (decision for surgery). This modifier will help ensure that both the E/M and the surgical procedure are paid.

This tip is adapted from “This month’s coding Q&A” in the September issue of Briefings on APCs

Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

    Briefings on APCs
  • Briefings on APCs

    Worried about the complexities of the new rules under OPPS and APCs? Briefings on APCs helps you understand the new rules...

  • HIM Briefings

    Guiding Health Information Management professionals through the continuously changing field of medical records and toward a...

  • Briefings on Coding Compliance Strategies

    Submitting improper Medicare documentation can lead to denial of fees, payback, fines, and increased diligence from payers...

  • Briefings on HIPAA

    How can you minimize the impact of HIPAA? Subscribe to Briefings on HIPAA, your health information management resource for...

  • APCs Insider

    This HTML-based e-mail newsletter provides weekly tips and advice on the new ambulatory payment classifications regulations...

Most Popular