At times, the primary care pediatrician may have to care for a patient in the emergency department (ED). When this occurs, what is the appropriate way of coding for reimbursement? The code(s) you use will depend on the following factors:

If you have arranged for a patient to meet you at the ED and you are the physician primarily managing the patient, you should use the ED evaluation and management (E/M) codes. The ED E/M codes may be used by any physician who provides services in an ED. An ED is defined for Current Procedural Terminology (CPT) purposes as a specified area of a hospital available 24 hours a day for the provision of unscheduled care for conditions that require immediate medical attention. A freestanding urgent care center, even if owned by a hospital, does not qualify for use of the ED E/M codes.

The ED E/M codes differ from...

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