tci ED Coding & Reimbursement Alert - 2001 Issue 8

Coding Nonemergent ED Services for Reimbursement

Receiving reimbursement for nonemergent cases can be difficult because although the Emergency Medical Treatment and Active Labor Act (EMTALA) regulations state that the hospital cannot refuse a medical screening exam (see box on page 60), the carrier bases payment strictly on the level of medical decision-making or on the diagnosis submitted. A carrier might reduce or deny payment for nonemergency services performed in the ED or pay the hospital only -- and not the physician -- if it determines the presenting problem, as described by the submitted diagnosis, was not an emergency. Medicare states that emergency codes must...

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