Editor’s Note: Cutting through the red tape to make certain that you get paid for every dollar you earn has become more difficult than ever, particularly in our current climate of health care reform and ICD-10 transition. The ACEP Coding and Nomenclature Committee has partnered with ACEP Now to provide you with practical, impactful tips to help you navigate through this coding and reimbursement maze.
Question: EMS called in for orders on a patient in the field. Can I bill for that?
Answer: Yes, but many payers do not cover it. There is a CPT code, 99288, for EMS direction, and it covers two-way voice communication. The clinician can direct EMS personnel to perform medically necessary procedures within EMS providers’ scope of practice, including medication administration, cardioversion (chemical or electrical), intubation, CPR, newborn delivery, and management of peri-arrest situations. Just getting a notification call does not constitute EMS direction, and the direction must be for advanced life support treatment but is not limited to only advanced life support procedures. Some payers bundle 99288 into the emergency department evaluation and management (E/M) CPT codes (99281–99285 and 99291), noting it is part of the E/M service; however, other payers do not cover the service because they require face-to-face time during an encounter. Check with your local payers to determine who will pay for this lifesaving service. Carefully document the EMS direction and the medical necessity required for the service.
Brought to you by the ACEP Coding and Nomenclature Committee.
Dr. Lempert is chief medical officer, coding policy, at TeamHealth, based in Knoxville, Tennessee.