Ambulatory Coding & Payment Report
Reader Question: Fast Track in the ED
Question: The fast-track portion of our ED uses both the same triage RN and registration staff. RNs float between the ED and the fast-track area. Because our patient-accounts department says payers are denying claims billed with the urgent-care revenue code, we are using 99281-99283. Would it be appropriate to use the ED revenue code for these patients? This is not a designated area with its own hours; it is simply a fast track through our ED, 24 hours a day, with the same ED staff.
Montana Subscriber
Answer: This question raises several issues. The patients arrive at the ED for care not knowing where they will be treated. Triage determines where they will go. EMTALA states that these patients must receive an appropriate medical screening exam (MSE) regardless of which area of the hospital treats them. The fact that the staff is the same for both the regular and fast-track ED means training and treatment are the same.
In this instance you should use the CPT codes for the ED, the 99281-99285 series (ED visit for the evaluation and management of a patient). Using codes that reflect a less acute site of care will make it appear the acuity of the patients' condition and treatment is less than it really is. This could affect future payments because all payers, private and government, are keeping detailed usage statistics on all sites of service. This same rationale applies to the revenue center. Whatever you call it, the fast track is the emergency department, so your revenue-center codes should correspond to the CPT codes used.
There are no CPT codes for urgent-care centers, and most payers will instruct you to use the office/outpatient codes 99201-99205 (office or other outpatient visit for the evaluation and management of a new patient). It is not correct to use these for the ED -- or your fast track -- with unscheduled visits.
Montana Subscriber
Answer: This question raises several issues. The patients arrive at the ED for care not knowing where they will be treated. Triage determines where they will go. EMTALA states that these patients must receive an appropriate medical screening exam (MSE) regardless of which area of the hospital treats them. The fact that the staff is the same for both the regular and fast-track ED means training and treatment are the same.
In this instance you should use the CPT codes for the ED, the 99281-99285 series (ED visit for the evaluation and management of a patient). Using codes that reflect a less acute site of care will make it appear the acuity of the patients' condition and treatment is less than it really is. This could affect future payments because all payers, private and government, are keeping detailed usage statistics on all sites of service. This same rationale applies to the revenue center. Whatever you call it, the fast track is the emergency department, so your revenue-center codes should correspond to the CPT codes used.
There are no CPT codes for urgent-care centers, and most payers will instruct you to use the office/outpatient codes 99201-99205 (office or other outpatient visit for the evaluation and management of a new patient). It is not correct to use these for the ED -- or your fast track -- with unscheduled visits.
- Published on 2001-08-01
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