# Patient triaged then left E.D.



## mmunoz21

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????


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## jimbo1231

*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


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## mitchellde

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.


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## ansada

lwbs no charge v64.3


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## jnewberry

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


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## lcox1974

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.


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## Rita Bartholomew

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.


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## nurseauditor

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


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## LLovett

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


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## eadun2000

katmryn78 said:


> 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.


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## LLovett

If you could provide me documentation of that I would greatly appreciate it. The ED at our hospital got in trouble for doing that and had to stop based on the above info I posted. I don't code/audit for them but we report thru the same chain and I go to many meetings where this is discussed. I would love to give them good news.

Thanks

Laura, CPC, CPMA, CEMC


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## mitchellde

Laura,
The facility E&M is dependent on the facility created assement criteria for a level one and is based on the utilization of the facilities resources.  When you say they got in trouble for this can you tell me by whom and exactly what the problem was .  Because a nurse triage alone is definitly billable from the facility standpoint.


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## mmunoz21

Thank you for all the replies...............


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