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Elizabeth M. Whitehorn, Director

Provider Notice issued 05/23/12

Emergency Department Facility Level Coding Guidelines

To:​

Participating Hospitals: Chief Executive Officers, Chief Financial Officers, and Patient Accounts Managers​

​Date:

​May 16, 2012

​Re:

Emergency Department Facility Level Coding Guidelines​

The purpose of this notice is to inform hospitals of Healthcare Common Procedure Coding System (HCPCS) “G” codes that have been added to the HFS reimbursement policy for Emergency Room (ER) claims. These new codes can be billed in conjunction with the appropriate Emergency Room Revenue Code effective with dates of service on or after December 1, 2010.

In order for the department to appropriately reimburse hospitals for services provided in the ER, hospitals should adhere to the following guidelines:

  • Revenue Code 0450 (Level I) must be billed with one of the following HCPCS Codes: 99284, 99285, 99291, G0383, or G0384

  • Revenue Code 0456 (Level II) must be billed with one of the following HCPCS Codes: 99282, 99283, G0381, or G0382

  • Revenue Code 0451 (Non-Emergency/Screening Level) must be billed with the following HCPCS Code: 99281 or G0380

If a claim contains one of the above ER revenue codes, there must be at least one of the above CPT/HCPCS Codes reported next to one of the appropriate revenue codes.

The final page of the APL Group Order document on the department’s Web site has been updated to identify the G codes as appropriately billable with the ER Revenue Codes. Questions regarding this notice may be directed to the Bureau of Comprehensive Health Services at 1-877-782-5565.

Theresa A. Eagleson, Administrator

Division of Medical Programs