Services Provided in the Emergency Room

The following three factors determine the appropriate visit fee to bill when service is provided in the emergency room:

  • If the physician is the designated emergency room physician (doctor of the day);
  • Where the physician is located when called to the emergency room; and
  • The time of day.

The following examples illustrate the correct billing for different situations:

Example 1:

Physician is the emergency physician designated by the medical staff, and is on hospital Emergency Department duty and is on-site:

What to bill:
Bill the appropriate fee item from the 01800 series in the Emergency Medicine section of the MSC Payment Schedule.

Note:

For additional information, please refer to the Section of Emergency Medicine Preamble.

Example 2:

Physician is already at the hospital when called to see a patient (age 35) in the emergency room but is not on a scheduled shift in the emergency room.

What to bill:
Bill the appropriate On-call On-site hospital visit fee if service is between 1800 and 0800 hours, or on a Saturday, Sunday or Statutory Holiday (i.e., 00113, 00105, or 00123). For weekday services between 0800 and 1800 hours, bill the appropriate out of office visit fee (e.g.: 13200).

Tip:
Please refer to Out-Of-Office Hours Premiums section in the MSC Payment Schedule.

Example 3:

Physician is called from home to attend a patient in the emergency room on an urgent basis.

What to bill:
General Practice physicians should bill the appropriate out of office visit fee plus call-out charge if out-of-office hours, or the appropriate emergency visit fee (e.g.: 00112) if during a weekday (call placed between hours of 0800 and 1800 hours).

Disclaimer: MSP Tutor is intended to provide a guide for physicians and medical office assistants in billing claims to MSP. For definitive information on fee-for-service fee item codes and amounts, consult the current MSC Payment Schedule. If a discrepancy exists between the information contained in MSP Tutor and the MSC Payment Schedule, the information in the Payment Schedule will prevail.

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