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July 2014

Here’s more of what you need to know about ER visits spanning more than 1 day

In the May Record, we published an article about emergency room visits that span more than one day. The article indicated that you must report the date span on the ER revenue code line to help ensure that all services provided during an ER visit are paid promptly. Here are some additional details to keep in mind.

All Blue Cross Blue Shield of Michigan trading partners** should follow these reporting requirements when using outpatient bill type 131.

When the emergency room visit spans more than one day, report the dates at claim level in Loop 2300 and also do the following:

  • Report qualifier “434” in segment DTP01.
  • Report qualifier “RD8” in DTP02.
  • Report the “from” and “to” dates in DTP03.
  • Report the date span on the ER revenue code (045x) line in Loop 2400.
  • Report qualifier “472” in Segment DTP01.
  • Report qualifier “RD8” in DTP02.
  • Report the range of dates in DTP03.

Contact your software vendor or clearinghouse if you need assistance with your practice management system. For questions about 837 electronic claims, call the e-BIG/EDI Business Helpdesk at 1-800-542-0945.

**This includes Federal Employee Program® trading partners.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2013 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
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