Definition

Emergency department (ED) services are E/M services provided to patients in the Emergency Department.

Explanation

These services may be billed by any specialty physician, not just Emergency Department physicians. The physician does not need to be assigned to the ED. However, these codes may only be used in a hospital-based facility that is available 24 hours/day for unscheduled care to patients who present for immediate medical attention.

Codes

99282, 99283, 99284, 99285 – Emergency Department Visits, and in some cases, the office (99202-99215) and outpatient/consult codes (99242-99245.)

Coverage

Most insurers will pay for services provided in an Emergency Department, however many payers will deny claims if they believe the patient’s condition did not require emergency care. These are diagnosis related denials. Some states have a Prudent Lay Person Law. If a prudent lay person believes that the condition is an emergency, the insurance company is required to cover it.

A physician called to the ED in consultation to see a Medicare fee-for-service patient should bill an ED visit if the patient is discharged from the hospital.