ED Coding and Reimbursement Alert

Question: Our group just started staffing a free standing ED. What place of service should I use for those ED claims?

Florida Subscriber

Answer: It depends on whether the facility is really an ED or actually an urgent care center. If it is licensed as an emergency department, use corresponding place of service code 23. Otherwise, use place of service code 20 for Urgent Care, which is defined as a location, distinct from a hospital emergency room, an office, or a clinic, whose purpose is to diagnosis and treat illness or injury for unscheduled, ambulatory patients seeking immediate medical attention.

The distinction for licensing as an ED can vary state to state based on Certificate of Need (CON) status, if it is owned by a hospital, whether it is open 24/7, and whether it accepts the responsibilities associated with providing EMTALA mandated care to all patients.

If the facility is licensed as an ED, you can use the ED E/M codes to report physician services. Otherwise, use the appropriate office or other outpatient setting code. Don't forget that you would have to use established patient codes for returning patients in an urgent care center.