Emergency Services

20.1.2.2 - Emergency Services (Rev. 2573, Issued: 10-26-12, Effective: 04-01-13, Implementation: 04-01-13) Emergency room services performed in hospitals, including CAHs, are excluded from SNF CB for beneficiaries that are in skilled Part A SNF stays. Hospitals report emergency room (ER) services under the 045X (Emergency Room -”x” represents a varying third digit) revenue code with a line item date of service (LIDOS) indicating the date the patient entered the ER. Services related to the ER encounter are also excluded from the SNF CB provision. “Emergency” services are defined in the regulations at 42 CFR 424.101 as “. . . services that are necessary to prevent death or serious impairment of health and, because of the danger to life or health, require use of the most accessible hospital available and equipped to furnish those services.” In this context, “false alarm” situations may occasionally arise, in which the initial assessment of a beneficiary’s condition as life-threatening subsequently proves to be unfounded (for example, where a patient’s chest pain and shortness of breath initially appear to be symptoms of a heart attack, but upon subsequent examination turn out to be merely a bad case of indigestion). Such situations still qualify for the emergency services exclusion from SNF CB as long as the initial symptoms provided a reasonable basis for assuming the onset of a medical emergency, even though this assumption ultimately was not borne out by subsequent events. Where services related to the ER encounter span more than one service date, hospitals must identify those services by appending a modifier ET (Emergency Services) to those line items. The reporting of the ET modifier will alert CWF that these are related ER services performed on subsequent dates so the SNF CB edits in CWF will be bypassd.