Patient came into the office (Urology) for scrotal swelling. Doctor examined patient – who was a new patient – and sent him to the ER for an emergent ultrasound to rule out abscess or torsion. He saw the patient in the ER later and ended up doing surgery. Both E&Ms got billed and, weirdly, they got paid. Then BCBS wised up and took back the money on the hospital charge. I know if the patient gets admitted from the office, you essentially build the office visit into the admission code, but what about this situation? Can we bill both? We’re querying the doctor to see if he planned to see the patient in the ER or if he was on call and got called in when the ultrasound was read. If it’s the latter, we might have a leg to stand on in appeal, but what if it’s the former?

Thanks!!!

Patient came into the office (Urology) for scrotal swelling. Doctor examined patient – who was a new patient – and sent him to the ER for an emergent ultrasound to rule out abscess or torsion. He saw the patient in the ER later and ended up doing surgery. Both E&Ms got billed and, weirdly, they got paid. Then BCBS wised up and took back the money on the hospital charge. I know if the patient gets admitted from the office, you essentially build the office visit into the admission code, but what about this situation? Can we bill both? We’re querying the doctor to see if he planned to see the patient in the ER or if he was on call and got called in when the ultrasound was read. If it’s the latter, we might have a leg to stand on in appeal, but what if it’s the former?

Thanks!!!