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Issue 2006-04, April 2006
MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
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Outpatient Prospective Payment System (OPPS) Hospital Emergency Room Services Exceeding 24 Hours
Provider Types Affected
Physicians, providers, and suppliers who submit hospital emergency room claims paid under the OPPS to Medicare fiscal intermediaries (FI)
Background
This article, based on CR4252, informs OPPS hospitals about proper billing requirements of emergency room services exceeding 24 hours. This policy can be found in the Medicare Claims Processing Manual, Chapter 4, Part B Hospital (Including Inpatient Hospital Part B and OPPS, Section 180, Accurate Reporting of Surgical/Medical Procedures and Services). This section is attached to CR4252.
Key Points
Hospital OPPS claims submitted for emergency room services should be billed in the following manner:
- The emergency room is identified with revenue code 045X.
- The service date is the date the service was provided in the emergency room.
- If the patient was in the emergency room after midnight, only one service date should be entered, i.e., the date the patient entered the emergency room.
- Service units should be one.
Relevant Links
The official instruction issued to your Medicare FI regarding this change may be found by going to http://www.cms.hhs.gov/Transmittals/downloads/R881CP.pdf  on the Centers for Medicare & Medicaid Services (CMS) Web site.
Please refer to your local FI if you have questions about this issue. To find the FI’s toll-free phone number, go to http://www.cms.hhs.gov/apps/contacts  on the CMS Web site.
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.
Pub. 100-4, Transmittal# R881CP, CR# 4252
Medlearn Matters Number: MM4252
Related CR Release Date: March 3, 2006
Effective Date: April 3, 2006
Implementation Date: April 3, 2006
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