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Can we bill E/M for patient who is triaged but leaves AMA?

  1. #1
    Location
    Spokane, WA
    Posts
    35
    Red face Can we bill E/M for patient who is triaged but leaves AMA?
    Medical Coding Books
    I do not do Hospital Billing currently but have been asked if it is appropriate to bill if the patient leaves the ED before being "seen" or being "treated" by the physician. I am under the impression that you can charge a low level E/M if they are triaged and then leave AMA if the documentation supports it...since the patient's vitals would have been taken, the reason for the visit would have been documented and there may have been "Standing Order" tests performed, like an EKG for chest pain or a pulse oximetry, etc. If the documentation supports the medical necessity of all tests performed and the severity of the presenting problem is clearly defined, and the ED consistently follows the same protocol for all patients who leave AMA, I think the ED should be able to bill the appropriate E/M with a status code of 07??? Any insight would be very helpful. Thanks~!
    T

  2. Thumbs up
    Yes, as long as all of your bullet requirements are met and there is some sort of MDM initiated by nursing staff, eg. order for lab or EKG, oral meds, etc you can charge a 99281 for the triage.

  3. #3
    Default Stop, Think about it!
    You can charge the patient for services, but you cannot bill the insurance company if you do not have HPI/PE/MDM (ER is 3 out of 3). These elements have to be documented by a doctor and you don't have that with LWOBS. You will find yourself in the middle of RAC reimbursement. You may want to implement a form that mimics an ABN if the patient leaves without being seen.

    Melissa Freeman, RHIT,CCS-P,CPC

  4. #4
    Location
    Columbia, MO
    Posts
    12,945
    Default
    If you are billing for the facility, as long as you meet the facility requirements for a level 1, 2, 3, 4 or 5 then that is what you may bill. The hx, exam, decision making is all for the physician and has no bearing on the facility encounter level. The facility should have facility criteria for the visit level that is followed for all patients. It is very different from physician. Also there are HCPC II codes for ER facility encounters, that some payers would prefer be used.

  5. #5
    Default
    I agree with mitchell. That is exactly how we do it in our ER. We also have a form that we created for AMA/LWOBS. It helps us show that the pt leaving is documented in the chart. We try to get the patient to sign it before they leave. They don't always comply and sometimes leave without letting anyone know. Also, we use t-sheets here (unfortunately..lol) for the pysician and another one for the nurses so the nurse t-sheet has the facility level fees documented on it and that is what we always charge for. If we went through the triage process and the patient had vitals, HPI, ect. done, then you can definitely charge for that.

  6. #6
    Red face ???
    How are you justifying E&M levels when you don't meet the minimum requirements for an evaluation and management services.

  7. #7
    Location
    Columbia, MO
    Posts
    12,945
    Default
    The facility is different. The facility does not have guidelines to follow like the physician. The facility is required to come up with their own guidelines that they must follow, so they can make the determiniation as to exactly what constitutes a minimal visit. They just have to follow the same quidelines for each patient. It may not sound right but remember the facility must account for the utilization of their resources.

  8. #8
    Default
    Our facility charges for it. Our physician's do not.

  9. #9
    Default ???
    Quote Originally Posted by mitchellde View Post
    The facility is different. The facility does not have guidelines to follow like the physician. The facility is required to come up with their own guidelines that they must follow, so they can make the determiniation as to exactly what constitutes a minimal visit. They just have to follow the same quidelines for each patient. It may not sound right but remember the facility must account for the utilization of their resources.
    Where is this referenced? Or is this just standard practice? If this is true, what is stopping facilites from charging higher level E&M for AMA if this isn't standardized for facility charging? Does the insurance companies know that they are being charged for AMA's? What diagnosis are being assigned for these type visits? Symptoms only documented by a nurse?

    Melissa

  10. Default E/M w/ AMA Facility side
    EVEN IF THERE IS NO WORK-UP but the pt was triaged, put in a room, had one or more of the following things done, meds p.o, put on a cardiac monitor, changed into a gown, etc YOU CAN CHARGE for this visit. Again, this is for the FACILITY.

    Now if you have a pt who has done all this w/ a CC of Chest Pain, SOB, Syncope, why would your ER MD let this person leave without seeing them or attempt to see them? Probably won't happen in 8 out of 10 cases, but it does happen. This AMA would get charged at my facility, probably a low level because no tests were done but there will be an H&P by the MD to accompany why the pt left AMA and what we tried to do to get them to stay.

    As stated in earlier comments about this, the facility should come up w/ a guideline and treat all the pt's the same.

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