tci ED Coding & Reimbursement Alert - 2019 Issue Q4

ED Visits: Part B MACs, Private Payers Launch Probes of ED E/M Codes

You’ll need to stay on guard. Billing ED visits may seem simple at first glance, but recent CMS data indicates that for Part B providers, it may be more complex than you think. Here’s why: Several Medicare Administrative Contractors (MACs) have listed CPT® codes 99281-99285 (Emergency department visit for the evaluation and management of a patient …) on their Targeted Probe and Educate (TPE) active review lists. What that means: TPE is a Medicare claims review process performed exclusively by the MACs. TPE targets at-risk providers and consists of three rounds of review, in which...

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