tci ED Coding & Reimbursement Alert - 2004 Issue 6

Reader Question: Check Payer Policy When Billing 99288

Question: Recently Medicare denied our claim for emergency care code 99288. This was our first time using this code. What could we have done wrong?Vermont Subscriber Answer: Medicare doesn't pay separately for 99288 (Physician direction of emergency medical systems [EMS] emergency care, advanced life support) because it considers payment for the service included in E/M codes 99281-99285 (Emergency department visit for the evaluation and management of a patient, which requires these three key components ...).Although some private payers accept 99288, check with you carrier before submitting the claim in order to prevent denials. If the carrier pays...

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