Billing question (emergency department)

[tennisall]

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Hi all,

When using outpatient billing codes in ED psych consultations, I know you need 2 of 3 categories to be high risk for MDM.

Often, billing a 99215 depends on the “number and complexity of problems” section and marking “• 1 or more chronic illnesses with severe exacerbation, progression, or side effects of treatment” for the presenting problem.

However, if a patient has been there a few days and they’re somewhat improving (e.g reduced suicidality but still deciding on hospitalization, do they still meet “1 or more chronic illnesses with severe exacerbation” because that’s how they initially presented and is the context of their general presentation to the ED?

 

[J ROD]

Depending on how much better they are I bill 99214 or 99213. On the initial evaluation I do a 90792 as well.

 

[calvnandhobbs68]

I think you'd be hard pressed to state that a patient still needs psychiatric hospitalization if you're billing them as a 99213 unless you're billing it based on time rather than complexity, but that's just me.

I agree that generally if we're still stating someone needs psychiatric hospitalization, that would be a 99215.

 

[Jules A]

I bill 90792 for evals and 99215 for follow ups. As calvnandhobs6 noted if they are sick enough to be waiting for inpatient bed they should meet the criteria based on complexity.