Name of Manual - Blue Cross and Blue Shield of Minnesota

Coding Policies and Guidelines (Medical Emergency)
Introduction Some subscribers have full coverage for an outpatient medical
emergency, which we generally define as the sudden and
unexpected onset of a condition requiring immediate medical
attention. To receive full benefits, the subscriber must seek care
within specified time limits, usually within 24 to 72 hours of the
onset of acute symptoms. Accidental injury may not be included in
the medical emergency benefits. Many coverage plans have
separate first-aid or accident benefits.
Criteria for Medical
Emergencies
11-2
Use the guidelines below to determine if you should submit a
claim as a medical emergency. Medical emergency charges
should be submitted with the date and time the emergency
occurred. If the emergency is related to pregnancy, also indicate
that the charges were for emergency services.
Were the symptoms sudden, severe and life threatening?
Did the condition require immediate medical (not surgical)
attention?
Did the patient see a doctor no later than 72 hours after the
problem began?
Did the time or date of the visit indicate it was an emergency?
The following situations generally would not indicate a medical
emergency:
scheduled surgeries or diagnostic procedures such as colon or
IVP X-rays
follow-up visits for further injections, such as antibiotics
suture removal
urgent but non-life-threatening situations seen during regular
office hours
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (03/23/12)