Room and board question

A patient is seen in the ED at 7 pm on June 10th. The patient is determined to need inpatient admission. The ED doc calls the hospitalist who sees the patient at 10 pm, writes orders including "admit as inpatient." The patient is transported to their room at 2 am on June 11th.

The patient therefore was receiving inpatient care under the direction of a doctor with inpatient privileges but in the ED on June 10th.

On the claim the admission date would be June 10th but can a room and board charge be applied for June 10th?


  • Yes, a room charge would be applied (e.g. in a "virtual" IP bed in the ED), as you have a valid IP order for 6/10.

  • I agree with the previous response. If an Inpatient order is placed by a qualified provider, inpatient room & board would be applied to the claim based on the date & time of that inpatient order. Your facility's bed charge billing table might require a bit of updating, and you might come across a claim edit for the ED cost center (depending on how your electronic billing system is set up). Despite that though, Inpatient room & board would still be appropriate while the patient was in the ED.

  • Thanks both of you. Now, what kind of bed? Based on where they end up after surgery- ICU, ? Always a semi-private?

  • For the 10th, the Inpatient R&B cost center would go to the ED cost center since the patient was there at midnight census. The next day R&B would go to whatever the cost center is that the patient is located in at midnight. That is how our Epic system charges it anyhow. Our hospital system only had semi-private/multi-occupancy rooms during the Covid surges. But when we did, the rooms had to be set up appropriately in order for them to be charged as a multi-occupancy room. It was automatically set up in the system for that specific room to charge as multi-occupancy any time a R&B charge was created for that room. It was not created for entire clinical departments to charge i that way. We also have ED boarded Observation patients, whereas we bill Observation while patients are boarded in ED. Makes for some fun documentation conversations with the ED physicians at times, but it helps for better ED reimbursement and ED overflow reimbursement. Save Draft

  • I agree with the previous posters. If we have a valid inpatient order and the patient is being held in the ED, an inpatient room charge will drop with the revenue going to the Emergency Department. The accommodation code is private and the level of care is the level that was ordered, i.e., Med/Surg , Intermediate, ICU, etc. We are an Epic facility and the Bed Assignment Table is built to accommodate all levels of care in the ED. In our perfect world we pull nurses from the appropriate assigned unit to provide care consistent with that level.

  • we start IP room/board at time of initial IP admit order. Type of r/b charge is determined by the accom code entered by nursing staff prior to midnight. Bed that patient is in determines who gets the revenue [ED or RN unit].

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