mgriffiths Posted February 7, 2019 Share Posted February 7, 2019 So had a conversation at work today and was curious if any others had input: How does the billing work if I evaluate a patient in my FM clinic and deem the patient needs to be seen at ED? Does the insurance cover my evaluation/visit as well as the ED visit or only the ED visit? Does it matter if the FM clinic I work at is owned by the same hospital as the ED? At my last FM job it was a privately owned practice, and I was told that if I sent a patient to the ED I could still bill for my evaluation/visit, but today I was told that is not true. Now I'm not sure what to believe, but my current job is owned by the hospital. But, I find it hard to accept that if I send a patient to the ED I can't get reimbursed for making that decision. I never would, but seems like a major reason to not send an acute patient to the ED, or at least not to the partnering ED? It came up as my collaborating physician (CP) had a patient with dyspnea, leg swelling, and majorly positive D-Dimer. Obviously our immediate concern is PE or at least a DVT, so sending patient for Chest CT and US. We were hitting roadblocks and I mentioned about just sending the patient to ED to not delay treatment. CP mentioned about not being able to bill for our work - leading to my above question. Result: after rechecking patient's BP with measurement of 250/110 - ambulance called and patient went straight to ED and was admitted/treated for saddle PE. Quote Link to comment Share on other sites More sharing options...
thinkertdm Posted February 7, 2019 Share Posted February 7, 2019 Of course bill for your work. Could probably bill for a level 5, especially if you called and discussed with ed doc, and documented your concerns explicitly in your a/p. What if the patient didn't go the to ed? Is that a free visit to see you? What if every patient went to the ed after they saw you? are you now not billing anyone? I think if you discussed this with your coding specialist, they would laugh their asses off. Quote Link to comment Share on other sites More sharing options...
mgriffiths Posted February 8, 2019 Author Share Posted February 8, 2019 Kind of what I figured...but probably not a bad idea to ask the coders to have some support behind me when I talk with my CP. Quote Link to comment Share on other sites More sharing options...
SERENITY NOW Posted February 9, 2019 Share Posted February 9, 2019 FWIW, the UCC associated with our ED is in the same hospital system and they only send the patient one bill for the ED if the patient is sent. I'd imagine if you're not in same billing system you wouldn't be held to that. 1 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted February 9, 2019 Moderator Share Posted February 9, 2019 21 hours ago, SERENITY NOW said: FWIW, the UCC associated with our ED is in the same hospital system and they only send the patient one bill for the ED if the patient is sent. I'd imagine if you're not in same billing system you wouldn't be held to that. I used to work in a similar system. If we sent them to "the big house" they only got the big house bill. Quote Link to comment Share on other sites More sharing options...
Moderator ventana Posted February 10, 2019 Moderator Share Posted February 10, 2019 in private practice sending to the ER Yes the private practice still gets paid BUT Coming out of the hospital you will not get paid if you see on the same day Quote Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted February 13, 2019 Administrator Share Posted February 13, 2019 On 2/8/2019 at 5:21 PM, SERENITY NOW said: FWIW, the UCC associated with our ED is in the same hospital system and they only send the patient one bill for the ED if the patient is sent. I'd imagine if you're not in same billing system you wouldn't be held to that. If insurance gets two bills for E&M for the same patient, from the same system, for the same problem, on the same day, do you think they will pay the $200 family med bill, or the $2000 ED bill? THAT's why your current employer won't let FM bill. 1 Quote Link to comment Share on other sites More sharing options...
thinkertdm Posted February 14, 2019 Share Posted February 14, 2019 I would think that it is not up to the individual provider to decide this, but the billing department to sort it out. The bills you submit are used for a lot more than just billing. As a tiny cog in the big machine (which is what I understand you to be if you are sending a patient to an ED owned by your group) it is up to you to churn out patients, not waste time deciding billing issues like this. They pay people to do this. Fill out your superbill, and send it on. Someone will catch it. Quote Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted February 14, 2019 Share Posted February 14, 2019 Thank you Lord for this day, and for not requiring me in 36 years to have to worry about ICD/CPT codes. I don’t know how I avoided it but I’m sure thankful. 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted February 14, 2019 Moderator Share Posted February 14, 2019 44 minutes ago, GetMeOuttaThisMess said: Thank you Lord for this day, and for not requiring me in 36 years to have to worry about ICD/CPT codes. I don’t know how I avoided it but I’m sure thankful. me too. another advantage of only working em. Quote Link to comment Share on other sites More sharing options...
Guest JMPA Posted February 15, 2019 Share Posted February 15, 2019 Yes you can bill, and yes you will get reimbursed. If the patient was seen in the ED and a pulmonologist consult saw the patient, would the pulmonologist get to bill even if he saw the patient the same day? if you contributed to the patients care than you are entitled to reimbursement for your services. Most coders i know are happy to discuss their trade. Coders can be the most over looked yet critical people in the system. Quote Link to comment Share on other sites More sharing options...
kargiver Posted January 31, 2020 Share Posted January 31, 2020 Yes you can bill. See patients all day long from the FP clinic downstairs that require more extensive work-up or admission. 2 separate services, 2 separate bills. Quote Link to comment Share on other sites More sharing options...
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