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Billing for ED Services that cross days

Linda Posted Thu 25th of March, 2010 06:17:13 AM

The patient enters the ER. Mar.3, at 11:30 p.m., March 4th, at 12:30 a.m. the patient receives therapeutic infusion. We put a 25 modifier on the EM level with the date the pateint entered the ER, March 03, we put March 04 for the date for the infusion code, this was the date documented by nursing. Nowe we are getting an edit stating that we have an EM level with a 25 modifier but do not have an S or T procedure. According to CMS transmittal 1151, ER services with a 450 revenue code are to have the date the patient entered the ER. does this mean even though nursing documented they did the infusion March 4, when we enter the charge we can enter a service date of March 03, thereby, resolving the edit. Thanks Linda

SuperCoder Answered Thu 25th of March, 2010 07:39:57 AM

You are right. You need to report this service on the date of ER encounter. The transmittal says this about multiple dates in ED:

• Emergency room services are reported under the 045x revenue code
• The line item date of service for the ER encounter is the date the patient entered the ER even if the patients encounter spans multiple service dates
• For all other services related to the ER encounter ( i.e. lab, radiology, etc) the line item date of service reported is the date the service was actually rendered

The ET modifier for services spanning multiple dates is applicable to patients under Part A SNF admitted to the ER.

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