Patient Left Without Seeing Physician

[kschulte71]

If a patient is triage by the nurse but does not stay to see the physician nor receives labs, etc. can we bill for an ED Level 1 visit? I am getting conflicting information from in-house coders and our outside coding vendor. Any guidance you can provide is appreciated. Also, if you have a link to what is correct either way, even more appreciated.

 

[mitchellde]

The facility can bill a level based on the facility tool for the level met based on the resources used. The physician may not bill since the physician did not see the patient.

 

[KellyLR]

Patient LWBS

Hi,

Ask what the policy is for the facility when this occurs. At our facilities, if patient LWBS, it isn't billed.

 

[Sarah Ann]

The facility can bill a level based on the facility tool for the level met based on the resources used. The physician may not bill since the physician did not see the patient.

How about when the pt is NOT and emergency department patient? On the facility side can we bill for triage? I have read CMS has stated that ED's can bill for this, but what about office visits 99212-99215 (urgent care a stand alone)I'm just looking for info. that states we can or cannot bill for it.
Thanks!

 

[finch.pam@mccg.org]

Could someone provide where to find the policy on patients that were triaged but left before being seen, what can we bill for this? I need documentation to back it up if needed. Thank you

 

[keke74]

From my experience, the process of handling cases like this varies by facility. It is usually based on the facilities internal policies.

 

[TThivierge]

Hi KSChulte
I d bill CPT 99211 if only saw nurse then use Z01.89as first dx unless returning for certain type of follow up ongoing chronic ds. and end with dx Z53.8 on it in outatient setting. Yes at EMR setting billing minimum EMR CPT 99281 and then assigned dx Z53.8 If pt. leaves while talking to provider or refuse to follow medical instructions he or she may use one of the dx blocks of Z91
I hope this data is helpful
Lady T

 

[simqueen]

For Medicare, if a patient is not seen by a physician/NPP in the ED, the visit does not meet the "incident to" requirements and there is no billable service. CMS published an FAQ (updated in 2012).
Can hospitals bill Medicare for the lowest level ER visit for patients who check into the ER and are "triaged" through a limited evaluation by a nurse but leave the ER before seeing a physician?
No. The limited service provided to such patients is not within a Medicare benefit category because it is not provided i... more
No. The limited service provided to such patients is not within a Medicare benefit category because it is not provided incident to a physician's service. Hospital outpatient therapeutic services and supplies (including visits) must be furnished incident to a physician's service and under the order of a physician or other practitioner practicing within the extent of the Act, the Code of Federal Regulations, and State law. Therapeutic services provided by a nurse in response to a standing order do not satisfy this requirement.
For other departments, if there are orders from a physician and the patient is seen by a nurse, then the facility criteria for determining the level of service is utilized.