ED Coding and Reimbursement Alert

Question: Patients leave the emergency department several times a day without being seen by a physician. How can we report this so we can recoup some of the resources used during initial triage?

New York Subscriber  
Answer: Because no physician services are provided to these patients during triage, there is no way to submit a claim. In some cases, the facility may submit a nominal charge to cover nursing time (taking vitals, documentation of the presenting problem, etc.). Many emergency departments make an effort to convince the patient to stay, however, and keep a log of the reasons the patient left perhaps they were feeling better, or were frustrated at the length of time it took to be seen by the physician. This type of information can be used to improve ED care and lower the numbers of patients who leave without being seen. In addition, it is vitally important for the ED to document the attempts they made to have the patient stay and be seen. The federal EMTALA act could be evoked in the case of patients not being seen if the documentation to support the circumstance is not recorded.