Page 1 of 2 12 LastLast
Results 1 to 10 of 13

Patient triaged then left E.D.

  1. #1
    Default Patient triaged then left E.D.
    Medical Coding Books
    Patient comes in at 2:00 a.m., gets triaged, vitals and all...after a couple of hours the patient decides to leave without being seen by the physician, and without letting the staff know he is leaving..Ancillary staff saw patient leaving and notified nursing staff, but when nursing staff went outside they could not find the patient.

    What can the E.D. department bill for????
    Marilyn CPC, CPC-H, CEMC

  2. Default Not a Thing
    On the physician side there is nothing to code since the physician never saw the patient. This kind of case is usually called LWOT....Left Without Treatment. It is worth keeping track of LWOTs since the number of LWOTs is an indication of ED efficiency.
    I believe some EDs will bill a 99281 for the facility side in triage only cases.

    Jim

  3. #3
    Location
    Columbia, MO
    Posts
    12,531
    Default
    The facility is allowed to bill what ever level is met by their assessment tool. So based on the nurses documentation, and the elements of what your facility has established must be met for a level 1, 2, or 3, etc. It does not have to have physician involvement on the facility side.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    Default
    lwbs no charge v64.3

  5. #5
    Default
    You would not be able to code for anything on the professional side but you could code on the facility side according to their guidelines. We all get those types of patients from time to time. They decide they are really not that sick after all!


    Judy N. LPN, CPC,CCS-P

  6. Default
    On the facility side you would charge a level acorrding to what interventions the nurse performed before the patient left. At my facility if the patient is triaged as your example stated we woul code the reason the patient came in i.e sore thoart, stomach pain, foot pain and charge a level one (CPT 99281) for the E/M.

  7. #7
    Location
    Greater Portland (Maine)
    Posts
    129
    Default
    At our facility, we do not bill the patient for anything in these instances. We do not believe it is good for customer relations to do so.
    RCBartholomew, CPC-H, CEDC

  8. #8
    Cool
    Some facilities dont bill for pt reasons...some do a E/M nurse only but I must say after waiting 2 hours..I'd be stressed and think it was time to go too

  9. #9
    Default
    Based on CMS, you would not be able to bill a facility fee in this situation. The facility fee is incident to the provider. If the provider doesn't see the patient they aren't incident to.

    http://edocket.access.gpo.gov/2009/pdf/E9-26499.pdf

    I believe it starts on page 262, obviously there is a lot more to it than I posted below but that is the heart of the matter essentially.

    "Medicare makes payment for hospital
    outpatient services ‘‘incident to'' the
    services of physicians in the treatment
    of patients as described in section
    1861(s)(2)(B) of the Act. Section
    410.27(a)(1)(ii)"

    Laura, CPC, CPMA, CEMC

  10. Default
    Quote Originally Posted by katmryn78 View Post
    Based on CMS, you would not be able to bill a facility fee in this situation. The facility fee is incident to the provider. If the provider doesn't see the patient they aren't incident to.

    http://edocket.access.gpo.gov/2009/pdf/E9-26499.pdf

    I believe it starts on page 262, obviously there is a lot more to it than I posted below but that is the heart of the matter essentially.

    "Medicare makes payment for hospital
    outpatient services ‘‘incident to'' the
    services of physicians in the treatment
    of patients as described in section
    1861(s)(2)(B) of the Act. Section
    410.27(a)(1)(ii)"

    Laura, CPC, CPMA, CEMC
    Actually you can code a 99281 for the facility for doing the vital signs. A physician does not have to see a patient in order to code for "facility" levels. For instance, a patient comes to the ED to have blood drawn for whatever reason and they do not see an ED doctor. The facility can bill a level. Same as if a patient is triaged and has a x-ray ordered from triage but never sees a doctor because they decide to leave, you can still code a facility level.

Page 1 of 2 12 LastLast

Similar Threads

  1. Can we bill E/M for patient who is triaged but leaves AMA?
    By ttate in forum Emergency Department
    Replies: 20
    Last Post: 11-03-2015, 08:15 AM
  2. Patient left AMA....
    By cweavercpc in forum E/M
    Replies: 2
    Last Post: 01-10-2015, 09:34 AM
  3. Patient Left ER before being seen by MD
    By DMSB00 in forum Emergency Department
    Replies: 9
    Last Post: 10-19-2009, 11:33 PM
  4. Replies: 1
    Last Post: 04-09-2009, 09:55 AM
  5. Patient left AMA
    By randiroyder in forum E/M
    Replies: 2
    Last Post: 03-27-2009, 09:57 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.