Thursday, June 24, 2010

ET - modifier - Emergency services

ET  Modifier

Description : Emergency Services.

Required for Claims : Hospital emergency room services spanning multiple service dates.

Type of Bill: 13X, 85X

Coding Guidelines : The –ET modifier should be applied to line item dates of service on their outpatient bill types 13X and 85X that are different from the date of service for revenue code
0450 (Emergency Room).

General Guidelines :

Emergency room (ER) services performed in a hospital are excluded from SNF CB for beneficiaries that are in skilled Part A SNF stays. Hospitals report ER services under the 045X 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. Current CWF SNF CB edits have bypasses to allow ER related services with LIDOS that match the reported LIDOS on the 045X revenue code to bypass SNF CB edits.

Problems arise where services related to the ER encounter span more than one service date. Services related to the ER encounter performed on subsequent service dates are currently being rejected by the CWF because the LIDOS for these services does not match the LIDOS reported under 045x ER revenue code. In order to bypass services related to the ER encounter which are performed on subsequent service dates, hospitals must identify those services by appending a modifier ET (Emergency Services) to those line items. The CWF SNF CB edits shall be updated
to bypass those services related to the ER encounter performed on subsequent dates based on the ET modifier.

Example: Patient comes to the Emergency Room late on April 14th. The patient is not released from the emergency room until April 15th.

BILLING: Services with dates of service from 4/15 must have the –ET modifier applied.

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