HCFA addresses confusion with codes and ER charges
Coding professionals may have questions on how to bill for emergency room (ER) visits. The Health Care Financing Administration (HCFA) in Baltimore addresses one such question:
Question: Do you need charges with each surgical CPT (common procedure terminology) code? If it is an emergency room charge, does the charge go on the line with the surgical HCPCS (HCFA common procedure coding system) code?
Answer: When multiple surgical procedures are performed at the same session, it is not necessary to bill a separate charge for each procedure. It is acceptable to bill a single charge under the revenue code that describes where the procedure was performed (such as operating room, treatment room, emergency room, etc.) on the same line as one of the surgical procedure HCPCS codes and bill the other procedures using the appropriate HCPCS code and the same revenue code, but with "0" charges reported in the charge field.
If a surgical procedure is performed in the ER, the charge for the procedure must be billed with the ER revenue code. If an ER visit occurs on the same day, a charge should be billed for the ER visit and separate charge should be billed for the surgical procedure(s) performed. (Although, as described above, a single charge may be billed for all surgical procedures, if more than one is performed in the ER during the same session.)
We understand that some hospitals currently bill a single ER visit charge that includes charges for any surgical procedures that are performed in the ER at the time of the ER visit.
Under the outpatient prospective payment system, HCFA will require that hospitals bill separate charges for ER visits and surgical procedures. However, HCFA will postpone this requirement until Jan. 1, 2001, so hospitals will have sufficient time to separate charges if they do not currently do so.
To ensure proper payment under the new system, hospitals must bill separate HCPCS codes for the ER visit (using modifier 25) and the surgical procedure(s) even if they do not separate charges between ER visits and surgical procedures during the remainder of calendar year 2000.
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