ED Coding and Reimbursement Alert

Question: I am leading an emergency room Chargemaster committee. At our facility, we have both an emergency department (ED) and an urgent care center (Intermed). Patients use the same entrance to both the Intermed and emergency room.
We are finding ourselves at a standstill with our committee because we cannot decide what constitutes an Intermed or ED visit, and who should decide the type of visit. Are there any guidelines or advice on this subject?

Kathy A. Rae
Coding and Utilization Review
Zeeland Health Services
Zeeland, MI

Answer: Generally, if it is an unscheduled visit that registers at the ED registration area on hospital grounds with access to the 24-hour ED services, then it is an ED patient. The urgent care center becomes an area of the ED.

If, however, the urgent care visits are billed with a revenue code other that the ED revenue code, you should probably consider them to be other that ED visits. To qualify for an ED visit according to CPT, an emergency department is defined as an organized hospital-based facility for the provision of unscheduled episodic services to patients who present to immediate medical attention. The facility must be available 24 hours a day. As you do not specify the hours of your urgent care center or stipulate whether patients are seen in the main ED after urgent care center hours, more specific advice is difficult to provide.

Editors note: For more information on billing for urgent care centers in or adjacent to the ED, please see Pitfalls in Coding and Billing for Urgent Care Centers, in the January 1999 ED Coding Alert, and How to Choose the Right E/M Codes to Use in Urgent Care/Fast Track Centers in the April 1999 issue.