# LWBS Policy



## PeaPod1

Hello-
We are having controversy in our emergency department regarding patients who leave w/o being seen by a MD. 

Would anyone be willing to share their policy regarding this issue with us?

I would appreciate insight/policy on any/all of the following aspects:

Operational? Clinical? Medicolegal? Financial?

Cheers and many thanks in advance.


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## jimbo1231

*Lwbs*

As far as coding goes, there are typically no services to code on the physician side since LWBS by definition does not involve the ED physcian. There might be services to code on the facility side depending on hospital policy.
LWBS is an important metric in relation to patient throughput and satisfaction, overcrowding issues etc.
Is there anything specific you are looking for?


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## Sueedwards

We are discussing this issue in our ER as well right now.  We are trying to figure out the best way.... 

If the patient leaves prior to triage, he is LWBS charge (Zero) and V64.2. 

If the patient leaves after triage but before physician, then we charge for the facility side and code the presenting.  

But I would like to know how others are doing this.....


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## jimbo1231

*Metric*

Sue,

From what I have seen, yours is the most common approach. If the patient actually sees the physician, gets worked up, but leaves AMA, that is certainly billable on the physician side.
But LWBS is a key metric along with press gainey, patient satisfaction surveys, waiting time etc etc, Reducing LWBS is considered a key metric in overall ED efficiency. And produces more billable services for coders!

Jim


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## Sueedwards

thanks Jim... 

I was wondering are you going to Regional Conference?


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## jimbo1231

*Regional Conference*

Sue,

Are you referring to the conference in Chicago? I was considering that one. Unless there is another one?

Jim


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## Sueedwards

No that is the one I meant... AAPC in Chicago.


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## alices

*lwbs*

Hello everyone, we have had this very same discussion and per CMS, Q, can hospitals bill Medicare for the lowest level ER visit for pts who check into the ER and are Triaged throught a limited evaluation by a nurse but leave the ER befor seeing a physcian? A) No the limited service provided to such patients is not within a Medicare benefit ccategory because it is not provided incident to a phycisian svcs. Hospital outpatient therapeutic svc and supplies (including visits) must be furnished incident to a physicians svc and under the order of a physician or other practitioner practicing within the extent of the act, the code of Federal Regulations and State law. Therapeutic svcs provided by a nurse in response to a standing order do not satisfy this requirement.
So I would look further into this subject...thanks, alice


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## jimbo1231

Right. It looks like CMS did a 180 on triaged patients between 2011 and 2012. Wouldn't shock me if there is a reversal in 2013 since using the "incident to" concept for non physician services that are required by EMTALA can be argued. Kind of like the 3 Day Rule being redefined every year.


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## Sueedwards

Do you know where I can find that on the Medicare website?

thanks a bunch!!!!


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## alices

*re-lwbs*

Hi, I don't know if it was from the FAQ on the website or where, my paper only says CMS.gov and then the question /answer, and it says published 12/19/2007 updated 12/01/11..thanks alice


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## KBROWN77

*Link*

Here is the link to the CMS FAQ previously referenced.

https://questions.cms.gov/faq.php?id=5005&faqId=2297


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## Sueedwards

Thank you so much!!!


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