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CODING CORNER: Code Type-B ED Visits with Confidence -- Our Experts Show You How

Caution: Check before billing new G codes to non-Medicare payers


Five new G codes allow you to be more specific when reporting part-time emergency department visits. But before you use these codes, you must find out whether they鈥檙e appropriate for your facility.

The basics: The Centers for Medicare & Medicaid Services introduced the following new ED codes in the final rule for the outpatient prospective payment system (OPPS):

G0380 -- Level 1 hospital emergency visit provided in a type B department or facility of the hospital 鈥�

G0381 -- Level 2 hospital emergency visit 鈥�

G0382 -- Level 3 hospital emergency visit 鈥�

G0383 -- Level 4 hospital emergency visit 鈥�

G0384 -- Level 5 hospital emergency visit 鈥�

If your facility runs an emergency department that is open less than 24 hours a day, is located in a separate free-standing location from the hospital, and meets one of the following requirements, you may report the above G codes, says Eli Berg, MD, FACEP, chief executive officer of MRSI, an ED billing company in Woburn, Mass., and chair of National ACEP鈥檚 Reimbursement Committee:

鈥� (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department;

鈥� (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment;

鈥� or (3) during the calendar year immediately preceding the calendar year in which a determination under this section is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment.

Bottom line: CMS considers EDs that meet these requirements 鈥淭ype B鈥� and therefore eligible to report the new G codes.

Example: A hospital owns an off-site, non-24/7 ED that is licensed by the state as an emergency department. Using the new G codes would be appropriate for these patients.

鈥淭ype A鈥� EDs, on the other hand, should report codes 99281-99285 (Emergency department visit for the E/M of a patient) and 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes).

To be considered a Type-A ED, the facility or department must be open 24 hours a day, 7 days a week and meet at least one of the following requirements:

鈥� It is licensed by the state in which it is located under applicable state law as an emergency room or emergency department, or;

鈥� It is held out to the [...]

- Published on 2007-03-01