N.J. Admin. Code § 10:58-2.7

Current through Register Vol. 57, No. 1, January 6, 2025

Section 10:58-2.7 - Evaluation and management: emergency department and inpatient hospital services

(a) When a practitioner sees the patient in the emergency room instead of his or her office, the practitioner shall use the same codes for the visit that would have been used if seen in the practitioner's office. Records of that visit shall become part of the notes in the office chart.

(b) When patients are seen by hospital-based emergency room practitioners who are eligible to bill the Medicaid/NJ FamilyCare-Plan A fee-for-service programs, the appropriate HCPCS code is used. These "visit" codes are listed at N.J.A.C. 10:58-3.2.

(c) Critical care/prolonged services shall be covered when the patient's situation requires constant practitioner attendance which is given by the practitioner to the exclusion of her other patients and duties, and therefore represents what is beyond the usual service for the practitioner.

1. The critical care/prolonged services code shall not apply to monitoring pregnant women in labor.

2. Critical care/prolonged service shall be documented in the applicable records, as defined by the setting. The records shall show, in the practitioner's handwriting, the time of onset and time of completion of the service. Settings that are applicable are the office, hospital, or home.

3. The reimbursement for the "critical care" or prolonged services utilizes the time parameter, and is all-inclusive, meaning that it shall be the only payment for care provided by the practitioner to the patient at that time. The specific procedures performed during that patient encounter shall not be reimbursed in addition to the "critical care/prolonged services" payment.

N.J. Admin. Code § 10:58-2.7

Amended by R.2001 d.204, effective 6/18/2001.
See: 33 N.J.R. 1160(a), 33 N.J.R. 2188(a).
In (b), inserted "NJ FamilyCare-Plan A fee-for-service" following "Medicaid".