Editor’s Note: Cutting through the red tape to make certain that you get paid for every dollar you earn has become more difficult than ever, particularly in our current climate of health care reform and ICD-10 transition. The ACEP Coding and Nomenclature Committee has partnered with ACEP Now to provide you with practical, impactful tips to help you navigate through this coding and reimbursement maze.

Question: My emergency department frequently cares for patients while they wait for a bed in a psychiatric facility to become available. How do we code for these extended stays?

Answer: ACEP has long advocated for improved mental health care for behavioral health patients. To that end, the College has been working with the American Medical Association (AMA) to help clarify how to report the services provided by emergency physicians after the patient has been evaluated, treated, and medically cleared for psychiatric evaluation. Optimally, mental health patients requiring an inpatient level of care would be promptly admitted to a psychiatric facility or admitted to a medical unit pending transfer to a psychiatric facility.

Realistically, many patients end up being cared for in the emergency department until an appropriate inpatient psychiatric bed can be located and the patient transferred to another facility. ACEP asked the AMA CPT Editorial Panel how to report Days 2 and 3 of such a stay. In the July 2019 issue of CPT Assistant, the AMA instructs us to use subsequent observation codes to report these services. Please see the new ACEP Reimbursement FAQ on Mental Health at for detailed information on how to properly code and get paid for providing ongoing care to mental health patients.

Dr. Lemanski is associate professor of emergency medicine at UMass Medical School–Baystate Campus, ACEP’s alternate advisor to the CPT Editorial Panel, and chair of the ACEP Reimbursement Committee Workgroup 4.