Corporate Compliance

Can we bill for triage and admit for a patient who left before being seen?

Compliance Monitor, September 30, 2005

Q: If a nurse triages a patient in the ER setting and then takes the patient to a waiting room, but the patient leaves before the physician sees him or her, can we bill a level I for the triage and admitting process that we performed? If so, how should we code for this in order to get paid?

A: In the OPPS Final Rule, which CMS published in the November 2001 Federal Register, CMS stated that a facility can bill screening services when that facility's provider(s) did not provide any treatment. Depending on the nature of the services provided, it may be reasonable for the facility to submit a low-level E/M charge.

The decision about whether to charge the patient often depends on why the patient left, what services were provided while the patient was in the emergency department (ED), and what the internal policy is for this type of occurrence.

If the patient left after triage and no significant service was provided (and especially if the patient had a long wait and left angry, for example) an ED may elect not to charge this type of visit. Others will code and bill for triage-only visits to the level of service provided, which is usually a level I.

Even if you don't charge for the service, it is beneficial to assign a tracking code for triage only. This will reconcile the ED log and is also helpful for tracking ED statistics and performance.

Editor's note: Joe Rivet, CPC, CCS-P, of Henry Ford Health System, answered this question.

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