tci General Surgery Coding Alert - 2000 Issue 7

Surgeon-Coder Communication Critical for ED Services Payment

Nugget: Two main factors determine how emergency department services are paid when the surgeon saw the patient and where the patient ended up. National Medicare guidelines state that evaluation and management (E/M) services a surgeon provides to a patient in the emergency department (ED) should be billed using emergency department codes (99281-99285), unless these services qualify as a consult, critical care service or admission. Revised guidelines in section 15507 of the Medicare Carriers Manual (MCM) clearly state that non-ED physicians, including surgeons, should bill such services using ED codes even if the emergency physician who initially saw the patient...

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