CMS Pub. 100-04, ch. 6, § 20.1.2.2

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.