Health Information Management

Tip of the week: Diagnostic and therapeutic services performed in the ED require a physician order

APCs Insider, June 20, 2008

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Medicare requires an order for therapeutic or diagnostic services performed in the ED. The Medicare Benefit Policy Manual, Chapter 6, section 20.5.1, states:

Therapeutic services and supplies which hospitals provide on an outpatient basis are those services and supplies (including the use of hospital facilities) which are incident to the services of physicians in the treatment of patients. Such services include clinic services and emergency department services.

The services must be furnished in the hospital or in a hospital department that has provider-based status in relation to the hospital under 42 Code of Federal Regulations 413.65.

The services and supplies must be furnished on a physician’s order (or on the order of nonphysician practitioners working within their scope of work and in accordance with state and local policies), be rendered by hospital personnel, and be performed under a physician’s supervision. Visit the CMS Web site for more information.

Therefore, if an order is missing, you should educate your ED physicians and nurses to provide one.

(The above tip was excerpted from the July issue of APC Answer Letter. To view the issue, click here.)



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