Question: Now that the consult codes are gone, if I treat one of my patients in the ER, do I use an ER code instead?
Answer: Until now, typically a payer allowed only one provider to use the ER codes (99281-99285) per ER encounter. Recent changes to the consult rules may have changed this somewhat — it’s too soon to tell.
But if it is your patient, and you are seeing him in the ER and do not admit him, then the established office visit codes are the way to go. The CPT manual E&M “office and other outpatient visit” category specifies “other ambulatory settings,” and this includes the emergency department.
Bill Dacey, CPC, MBA, MHA, is principal in the Dacey Group, a consulting firm dedicated to coding, billing, documentation, and compliance concerns. Dacey is a PMCC-certified instructor and has been active in physician training for more than 20 years. He can be reached at firstname.lastname@example.org or email@example.com.
This question originally appeared in the May 2010 issue of Physicians Practice.