DEC 15, 2016
Billing for Procedures in the Emergency Department
Question: Our surgeon saw a patient in the emergency department and billed 99284 Emergency department visit that includes a detailed history, detailed examination and moderate medical decision making. He also performed CPT code 65285 Repair of laceration; cornea and/or sclera, perforating, with reposition or resection of uveal tissue on the same day. Can we bill the surgical procedure as well?
Answer: The surgical code has a 90-day global period; append modifier -57 to the ED visit. Make sure you use the correct place of service, 23, for exam and procedure.
Also confirm that the documentation meets the criteria for 99284. The history component must be in the physician’s own words and not just reference others’ work. Payers look at all exams, including emergency-department visits.