Wiki Facility Billing Emergency Dept.

[pdege]

Can a facility bill a patient or his/her insurance for an emergency department visit (99281, 99282) if the patient leaves without seeing a doctor? For example, a patient is triaged and then brought back to a room in the ED, maybe even has blood drawn or other tests due to protocol, but then before a doctor can actually see or treat the patient the patient decides to leave the hospital. The facility has provided services at an expense, but patient never sees an MD. Can Medicare or Medicaid be billed in a situation like this above? Please let me know if you have links to documentation that clearly specify an answer to this common scenario.

 

[mitchellde]

The facility may bill any insurance as long as the facility criteria for a visit level has been met. It is not dependent on the physician seeing the patient but rather what facility resources were consumed. Look to your APC guidelines for this information.