Q&A: Setting facility charges for LWBS patients in the ED

Wednesday, August 23, 2023

Q: If a patient in the emergency department (ED) leaves without being seen (LWBS) by a physician/nonphysician practitioner, should we have facility charges?

A: Yes. If facility resources were used and clinical documentation supports the facility charge, then it would be appropriate to have charges on LWBS patients. In the scenario provided, you would have an ED evaluation and management (E/M) level generated based on the leveling method (Cerner OCC, Optum Lynx, etc.) the particular facility, market, or division uses.  Assuming that triage was done by the ED/nursing staff, then it would most likely generate a low level (probably a level I) E/M, depending on the E/M leveling tool. In addition to the E/M level, you would also have the facility charges related to labs and x-rays, if applicable.

Editor’s note: This question was answered by NAHRI Advisory Board member Christian S. Gabriel, national director of revenue integrity at CommonSpirit Health in Dublin, California.