Emergency Medicine MSP Billing Tips

As an emergency physician, you’re typically in a high-stress environment treating a wide range of life-threatening conditions. This means you’re seeing a lot of new patients that require a variety of different treatments, tests, follow-ups and care plans.

Whether you’re working in a hospital emergency room or an urgent care facility you understand the importance of proper documentation for both your patient’s records and the hospital/facility. And while it might not always be the first thing on your mind, billing properly is also crucial so that you get paid for everything you do. You don’t want to under-code or miss out on any available premiums.

That’s why we’ve created an emergency medicine cheat sheet so you quickly reference all the available codes and make sure you’re billing them correctly and avoiding rejections. Rejections slow down your pay and can be time-consuming to resubmit.

Emergency Medicine Consultation Fee Code

01810 Emergency Medicine Consult

You can bill 01810 for any discussion with your patient or your patient’s family. For example, you can use it when discussing the lab, X-Ray or ECG results.

Keep in mind that if you bill it with 00081 or 00082 then the consultation represents the first half-hour of 00081/00082 (i.e. 00081/00082 may not be billed for that first half-hour).

00081 Emergency Medicine Bedside Care

Use this for any evaluation, diagnosis and treatment of a critically ill patient who requires constant bedside care. It covers the following procedures:

• Defibrillation

• Cardioversion

• Peripheral intravenous lines

• Arterial blood gases

• Nasogastric tubes with or without lavage Urinary catheters (as part of a cardiac arrest)

Don’t forget to include start and end times within your claim as it’s billable per half hour or major portion thereof.

A critically ill patient is defined as a patient with an immediately life-threatening illness/injury, for example:

• Cardiac arrest

• Multiple trauma

• Acute respiratory failure

• Coma

• Shock

  Cardiac arrhythmia with haemodynamic compromise

• Hypothermia

• Other immediately life-threatening conditions

00082 Emergency Medicine Critical Care Monitoring

Bill 00082 if you need to monitor your critically ill patient (only when modification of the care and active intervention isn’t necessary).

Don’t forget to include start and end times within your claim as it’s billable per half hour or major portion thereof.

00081 & 00082 Emergency Medicine Billing Example:

Your patient had a cardiac arrest and now requires continuous monitoring following resuscitation.

Bill 00081 for the time spent providing active resuscitation.
Bill 00082  for the time spent providing continuous monitoring of your patient afterwards.

When your patient’s condition is stable, bill follow-up care under the appropriate visit fees (e.g. 00108 – hospital visit).

00083: Emergency Crisis intervention

Bill 00083 if you’re the attending physician who is called to provide continuous medical assistance if your patient is in a crisis, such as rape, suicidal behavior, acute psychosis, or they just lost a loved one.

00083 Guidelines

This is not a stand-alone item, meaning you need to bill a consultation or physical examination first for the first full hour and then 00083 for each subsequent continuous half-hour or major portion thereof. Don’t forget to include start and end times within your claim. 

Tip: To get paid on time make sure you leave a short note in the MSP note field saying what the crisis was.

Example: You attend to your patient’s spouse for grief counselling following their sudden death. You speak with them from 9am to 10:10am.

Bill 00120 (no time added)
Bill 00083 (from 9:00 to 10:10am) with an explanation in the note’s field saying “sudden death of spouse.”

00120 is billed for the first half-hour. And then bill 00083 since the criteria is met (i.e. sudden bereavement and major portion of half-hour spent excluding first half hour). Only one unit of fee item 00083 is payable, as the additional 10 minutes spent is not the major portion of a half hour.

Medical billing in BC is confusing and can often be overwhelming. To help out, check out our complete MSP guide that walks you through each step of medical billing – from the general teleplan process to maximizing your claims and using mobile billing.

Emergency Medicine Department Level Codes by Time of Day

You need to bill depending on when you’re working and what level of service you provide in the emergency room. Review the options below to make sure you’re choosing the right billing code based on the day of the week and the level of service.

Emergency Medicine Level Guidelines:

• You can only bill this if you’re the emergency physician on duty.

• You’re not eligible for call out and continuing care premiums.

• When you change shifts, routine transfer of care doesn’t generate a new cl
  aim, it always stays with the first physician.

Level Descriptions:

Level 1: a single condition requiring only an abbreviated history, examination and treatment.

Level 2: the evaluation of a new or existing medical condition that needs a detailed medical history, and necessary physical examination of three or more regions. Or to patients whose illness/injury requires prolonged observation, therapy or reassessments. It includes a review of laboratory tests and x-rays.

Level 3: Scenario A: the evaluation of any patient who has serious multiple and/or complex medical problem(s) that needs a detailed history and complete physical examination. It includes a review of laboratory tests and x-rays, ECG studies, and discussion with your patient/or their family.

Scenario B: the management of a life-threatening illness/injury which requires immediate evaluation and emergent treatment. It includes a review of laboratory tests and x-rays, ECG studies, and discussion with your patient/or their family.

DAY: Monday to Friday 8:00am-5:59pm

01811: Day, Level 1

01812: Day, Level 2

01813: Day, Level 3

EVENING: Monday to Friday 6:00pm-10:59pm

01821: Evening, Level 1

01822: Evening, Level 2

01823: Evening, Level 3

NIGHT: Everyday 11:00pm-7:59am

01831: Night, Level 1

01832: Night, Level 2

01833: Night, Level 3

SATURDAY, SUNDAY, or STATUTORY HOLIDAY: 8:00am-10:59pm

01841: Saturday, Sunday or Statutory Holiday

01842: Saturday, Sunday or Statutory Holiday

01843: Saturday, Sunday or Statutory Holiday

Fractures & Dislocations Emergency Medicine Fee Codes

Fractures:

01850: Clavicle fracture: closed (adult)

You cannot bill this in addition to a visit or EM level code.

01851: Fibula fracture, shaft or malleolus – no reduction

Includes anaesthesia level 2.

Dislocations:

When billing for dislocations makes sure the location is ‘E’.

01860: Temporo-mandibular joint, closed dislocation
Includes anaesthesia level 3.

01861: Patella dislocation – closed
Includes anaesthesia level 2.

01862: Toe, closed reduction
Includes anaesthesia level 2.

Make sure you save a link to our MSP Emergency Medicine

searchable database. You can search by billing code or keyword.

MSP Emergency Medicine Fee Code Lookup

Final Takeaway:

Remember you have the option of “starring” your most commonly used billing codes. That way, they’ll appear at the top for searching.

If you find you’re getting a lot of MSP rejections spend some time figuring out why so you can fix and resubmit them. A lot of times MSP rejections are simple errors.

If you have any questions about emergency medicine fee codes or would simply like to clarify something, don’t hesitate to get in touch with us.

This article offers general information only and is not intended as legal, financial or other professional advice. A professional advisor should be consulted regarding your specific situation. While information presented is believed to be factual and current, its accuracy is not guaranteed and it should not be regarded as a complete analysis of the subjects discussed. All expressions of opinion reflect the judgment of the author(s) as of the date of publication and are subject to change. No endorsement of any third parties or their advice, opinions, information, products or services is expressly given or implied by RBC Ventures Inc. or its affiliates.

I had nearly 50% of my submissions rejected, but Dr.Bill conveniently followed up on them for me. It’s the most user-friendly service I have come across.

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