ED Coding and Reimbursement Alert

Question: On what day do I report an ED visit when the patient arrives and physician treatment begins at 11:30 PM on Monday but the emergency physician does not complete their full evaluation until after midnight on Tuesday morning? Kentucky Subscriber

Answer: Emergency department visits by nature are unscheduled and can begin at any hour of the day. As such it is not unusual for an ED visit to begin in the evening of one day and last several hours concluding after midnight on the next calendar day. Typically, the date of registration in the department is the one used as the date of service on the claim. Since ED E/M codes are not time or calendar day based, it should not impact your payment.

Of note: new language in the 2011 CPT^® book introduction reads, "For continuous services that last beyond midnight, use the date in which the service began and report the total units of time provided continuously." So the same concept would apply to critical care codes that transcend midnight.