We have patients who present to the ED and their physicians request the following services: that we insert a Foley, replace a peg tube, change a dressing, etc. In these cases, may we bill for an ED visit and the procedure that we perform? These patients are registered as outpatients rather than as ED patients.

It is inappropriate to bill a low-level ED visit in conjunction with this service. If your ED acts as an overflow clinic or provides clinic-type services on the weekend, after-hours, or when physician clinics are closed or backed up, you must develop a separate visit level structure or acuity system to account for your nursing time and resources expended. To bill these services, do the following:
• Use revenue code 510 and CPT codes 99201–99205 for new patients
• Use 99211–99215 for established patients
• Create separate and distinct “clinic” documentation forms from those you normally use for the ED.

One other note of caution: ED visits carry higher payment rates and copayments than those generated by
the clinic visit codes. By generating an ED visit level, you will have fraudulently reported the visit type and
received a higher payment than the facility was entitled to. Be careful.