For patients sake

Do you bill for ED visits? If you do, do you notice that the bills are being sent to the patient at the full price of the claim? This could be because the patients benefits only allow ONE emergency visit per DOS. The insurance companies will pay for the first received ED visit that they get. So if the physician that is employed at the hospital bill for a 99283 and then you as the other physician was called in for a consultation in the ED and you bills for 99283 only one of these bills will get paid, whoever gets the claim to the insurance the fastest.

So here is what I tell all of my coders because as a profee coder it is just as important to bill correctly to the provider as it is for the patient. So if your physician sees a patient in the ED, even if the POS is an ED visit you do not have to bill an ED visit. An Emergency Department visit is considered an outpatient visit. So the POS can stay as a 23 but your code can billed as a consultation, if the insurance accepts consultation codes (outpt) OR bill from the “office or OTHER outpt” services section of your CPT book, these codes are your 99202-99205.

If your clearing house rejects these claims as an error, this needs to be discussed with your clearing house or you EMR/EHR system. This becomes a burden for patients because an ED visit should only be billed one time on one DOS by one provider. Let the employed physician at the hospital have that ED visit. Bill for a consultation or an outpt visit. You will see a difference in your insurance A/R and your patient A/R. The billing department should understand this flow and should be able to help guide the patients appropriately.