Health Information Management

Tip: Coding for ED visit when the patient is admitted

APCs Insider, September 13, 2013

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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



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